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Craniopharyngioma surgery identification and protection of the pituitary stalk


Home center, observed from below the optic chiasm; and its lower end to volatile, depending on the location of the tumor and the real composition of pituitary stalk compression level. Pituitary stalk can be rounded in shape, can be huge in the tumor showed a sheet-like oppression, colors are mostly dark red, careful observation and more can be found on the surface texture longitudinal blood vessels, except a few cases (3 patients in this group) because block and the pituitary stalk calcification adhesion difficulties led to separation of protection, most cases of pituitary stalk tumor with intramural tumors can be separated from the interface there can be full reservation. It is worth noting that some cases (5 cases in this group) the bottom of pituitary stalk tumor and tumor-free for the separation of intramural interface,[link widoczny dla zalogowanych], pituitary stalk part of the tumor and the tumor fusion, this time to the best possible tumor removal, can lower remote as possible from the pituitary stalk off, 5 cases of patients in this group clearly found in the pituitary stalk transection in patients who were noted postoperatively diabetes insipidus of different degrees, but in 4 cases after 1 month recovery, and only 1 case diabetes insipidus after March remains a serious, need to continue hormone replacement therapy. Small number of cases, the pituitary stalk can be located on the side or in front of the tumor tumor, located in the side of the carotid artery were more lateral space in the separation of tumor capsule was found, careful analysis of the shape and direction of the upper and lower end of the line to go to the pituitary stalk can be judged. Cancer surgery in the pituitary stalk in front by more than the bottom found in the ipsilateral optic nerve. Should be noted that this group of pituitary stalk tumor location and tumor relationship is described by a relative concept, we will pituitary stalk into the relationship between tumor and tumor rear, top, front, side side, one is to combine imaging of tumor growth have an accurate grasp of the direction, the other is to separate the operation and protection of the pituitary stalk may encounter be aware of the neurovascular structures,[link widoczny dla zalogowanych], to improve complete resection rate of help. From this group the incidence of postoperative diabetes insipidus and postoperative outcome of view, although the discovery of surgery or pituitary stalk and immediate postoperative (after 4h) the occurrence of diabetes insipidus is not necessarily linked, but the pituitary surgery handle specific cases be maintained in the recovery of diabetes insipidus after surgery was significantly better than the pituitary stalk were not found,[link widoczny dla zalogowanych], indicating that the identification and protection of the pituitary stalk to improve the postoperative pituitary function in endocrine axis to determine the significance of This conclusion also Honegger ~ ¨ other point of view. In the pituitary stalk resection of craniopharyngioma reservations should be easier in theory, because such tumors and normal pituitary stalk and the interval to a clear separation of arachnoid level, as long as the strict separation along this level should be able to complete keep the pituitary stalk. We consider some cases can not be found and reserved main causes of pituitary stalk: ④ from the lower part of the pituitary stalk or intrasellar craniopharyngioma often broke into the saddle on the pattern of pituitary stalk compression as a thin, tight adhesion and the loss of not only the surface The longitudinal striated appearance,[link widoczny dla zalogowanych], resection of the tumor is often difficult to identify be removed; ② for the soft part of the membrane type of craniopharyngioma, especially the origin of craniopharyngioma in the third ventricle. ③ part of the craniopharyngioma pituitary stalk has been under pressure in the case of thin, clear calcification peritumoral adhesions, and the end of the third ventricle and pituitary stalk is no obvious separation between the levels to follow, so the identification and protection of the pituitary stalk more difficult . Imaging data can be found in the pituitary stalk to help, in some cases through careful observation of the third ventricle MRI scan direction of the front and the pressure shift and other Third ventriculostomy mamillary body structure and migration of tumor wall between the pituitary stalk for surgery identification and protection of useful information. The initial preoperative imaging to determine the pituitary stalk, 17 cases were confirmed by surgery. For most of craniopharyngioma, since larger tumors or tumors located in the third ventricle, third ventricle on the imaging front-end structure is not clear, not on the relationship between pituitary stalk and the tumor location to make judgments. The group found that patients in the pituitary stalk clearly accounted for 52.4% (33/63), significantly higher than preoperative imaging diagnosis.
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