第38回日本小児神経外科学会
The 38th Annual Meeting of the Japanese Society for Pediatric Neurosurgery

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第1日目、6月4日(金)A 会場(3階 メインホール)9:40〜10:40

特別企画 1: JSPN - KSPN joint session: 2. Management of craniopharyngioma

Chairperson: Kyu-Chang Wang, Takayuki Inagaki

SP1-2-1

Surgery of the Craniophayngioma

Young-Cho Koh, M.D., Ph.D.

Department of Neurosurgery, Konkuk University Hospital, Seoul, Korea

It is no doubt radical resection of this histologically benign but biologically malignant tumor is mandatory whenever possible, especially in pediatric ages. Either subfrontal or pterional approaches have been traditionally used in most cases of these tumors.
Among my personal series of 55 surgeries in 36 patients during the past 25 years almost 90% of cases have been operated by one of these approaches with or without translamina terminalis approach. Other approaches used include trans-sphenoidal approach with endoscope assist, transcallosal approach or combined approaches. Skull base techniques including orbitozygomatic approach, petrosal approach or pure endoscopic techniques were not used in my series. The youngest case was 11-month-old boy the eldest was 68-year old man of this series.

In the early stage of my microsurgical practice, bilateral or unilateral subfrontal approach had been favoured because they provided wider surgical fields and more anatomical perspectives. Getting more experiences in craniopharyngioma surgeries, frontolateral or frontotemporal approaches have been used more often in these surgeries resulting in similar postoperative results to those of subfrontal approaches.
Thirty patients(83%) achieved good postoperative results achieving KPS 90 or more. Fair results were obtained in four recurrent tumor patients. There were two operative mortalities, one in primary subfrontal approach and the other in recurrent subfrontal approach after partial removal followed by radiotherapy. The cause of death in these patients were hypothalamic injury and basilar artery injury followed by brain stem infarct, respectively. Gamma knife radiosurgery was given in five patients with asymptomatic radiologic recurrences without any adverse radiation effect.

Microsurgical techniques supplemented by microsurgery-assisted endoscopy or pure endoscopic techniques are requested to minimize morbidity and maximize radical resection in these formidable tumors.

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