두개인두종에 관한 임상적 고찰 = Clinical Features of Craniopharyngioma

다국어 초록 (Multilingual Abstract)

The present study involves 30 craniopharyngioma patients who were admitted to the Department of Neurosurgery, Yonsei Medical college from April, 1965 to December, 1978. All 30patients received surgery, the results of which were analyzed and evaluated as follows.
1. They consisted of 22 male and 8 female patients. Sixty percent of all patients were under 20 years of age.
2. Chief complaints were as follows: headache(80.0%), decreased visual acuity(80.0%), visual field cut (46.3%), nausea and vomiting(40.3%), papilledema(40.0%), optic atrophy(33.3%), diabetes insipidus(27.0%), and mental disturbance(27.0%).
3. They were diagnosed mainly by cerebral angiography until 1977, at times combined with pneumoencephalography, isotope brain scan, and Conray ventriculography. Since 1978 using the CT brain scan we have been able to reduce risk during and after neuroradiological study, and accurately determine location, size, shape and invasiveness of the tumor.
4. Surgical procedures were performed in 32 cases of craniopharyngioma using several approaches; transfrontal approaches; transfrontal approach: 29cases, transsphenoidal approach: 2 cases, and sterotaxic cyst puncture: 1 cases. In 8 cases (27.0%) total resection of the tumor was performed, subtotal resection in 23 cases (71.9%), and aspiration of the cyst in one case(3.1%).
5. In the above 32 surgeries, 24 cases(75.0%) of craniopharyngioma were performed by microsurgery, 8 cases involved total resection and 16 cases subtotal removal. As a result of microsurgery, it was possible to remove the tumor from the surrounding structures with less damage.
6. To manage hydrocephalus during the operation, extraventricular drainage was applied in 8 cases(27%) and in 7 cases(23.3%) ventriculoatrial or ventriculoperitoneal shunts were employed pre-or postoperatively.
7. Postsurgical radiation therapy was given to 8 patients in the dosage of 5000-7000 rad during 6 to 8 week period following surgery.
8. As a result of temporary hormonal dysfunctions after surgery, the following complaints were observed: diabetes insipidus, 16 cases(50.0%), hypernatremia, 7 cases(23.2%), and SLADH, 4 cases (12.5%). Three of the hypernatremia patients expired.
9. Evaluation of craniopharyngioma after surgery is as follows; improvement of preoperative symptoms and signs, in 22 cases(68.7%), no improvement of preoperative symptoms and signs in 4 cases(12.5%), aggravation of postoperative symptoms and signs in 3 cases (9.4%), and operative mortality in 3 cases(9.4%).