抄録
The long-term results of 22 adult cases with craniopharyngioma admitted to our hospital between 1960 and 1978 were studied. Out of 22 cases 12 were treated initially with palliative surgery in combination with irradiation or chemotherapy using bleomycin. Operative deaths were nil in this group. However, 10 cases showed deterioration of clinical signs and symptoms over and over again in spite of repeated treatment and finally died mainly of intracranial hypertension within 11 years after the initial surgery. In the remaining 10 cases radical removal of the tumor was performed initially via the bifrontal approach using an operating microscope. The operative deaths were also nil in this latter group. In the latter radical treatment group, tumors were classified into four principal types according to their locations and modes of extension; intrasellar, subtuberal, tuberal and ventricular types. Among four cases with a tumor of the tuberal type which had been radically resected, two cases showed severe diabetes insipidus and hypopituitarism following the operation and their daily activities were restricted because of postoperative mental disturbances. In three cases out of four cases of the subtuberal type in which craniopharyngioma had arisen in an intermediate position, between the gland below and the 3rd ventricle above, the pituitary stalks were preserved. In these three cases postoperative diabetes insipidus was mild and transient and functions of the anterior pituitary lobe were saved except for TSH secretion. All six cases including four subtuberal types and two intrasellar types returned to full working capacity after the operation.
The results mentioned above suggest that better long-term results can be obtained in the radical treatment group than in the conservative treatment group and therefore attempts should be made to remove craniopharyngioma radically, especially in cases of the subtuberal and the intrasellar types, making efforts to preserve the pituitary stalk if possible.
