Transsphenoidal approach for craniopharyngioma resection

Treatment of diseases: craniopharyngioma Indication Transsphenoidal approach for craniopharyngioma resection is applicable to: 1. Cystic or substantial craniopharyngioma that grows in the saddle or (and) the sphenoid sinus. 2. The saddle type merges with a small cystic craniopharyngioma that develops on the saddle. Contraindications 1. Nasal infection or chronic sinusitis, mucosal edema and congestion, prone to intracranial infection after surgery. 2. If the adult or sphenoid sinus is not well-formed, if the transsphenoidal approach is necessary, the bone in front of the sella should be ground with a micro-drill under the X-ray TV fluoroscopy. 3. The sphenoid sinus is over-vaporized, and the optic nerve and internal carotid artery can be exposed to the sphenoid sinus mucosa, which is easy to cause damage during operation. 4. Coronal CT scan showed that the tumor mass in the saddle and the sella was dumbbell-shaped, indicating that the saddle septum was small, and the transsphenoidal surgery was not easy to reach the saddle, and the saddle tumor was not easy to be seen after the saddle tumor was removed. Drop into the saddle during intracranial compression. 5. The tumor on the saddle is larger or extends to the anterior, middle, and posterior fossa. 6. The upper part of the tumor is larger, and the visual field of view is seriously damaged. The transsphenoidal surgery can not perform full optic nerve decompression, and the postoperative visual field recovery is not as good as transcranial microsurgery. 7. The saddle-shaped craniopharyngioma invades the sella, but does not reach the saddle bottom and the pituitary is located below the tumor. For example, transsphenoidal approach, after cutting the dura mater, first see the normal pituitary, difficult to find Tumors, and extensive exploration in the saddle can increase the pituitary dysfunction. Preoperative preparation 1. Imaging examination: CT and MRI scan to determine the condition of the lesion and the sella. 2. Repeat the intranasal lavage of the patient several days before the operation, or periodically add antibiotic solution. The nose hair was cut off 1 day before the operation, and washed, and the antibiotic solution was added dropwise. Surgical procedure 1. Incision under the lips or nose, into the sphenoid sinus and the sella. 2. After seeing the dura mater, such as the intracranial craniopharyngioma, common dural bulging, the surface is blue-black or dark green. A fine needle can be used to obtain a yellow, tan, green or black liquid with different consistency. The cystic fluid contains cholesterol crystals to confirm the diagnosis. After the dura mater is cut, the wall can be reached by a little separation, and a large amount of cystic fluid flows out after piercing. The wall of the capsule is smooth, the tumor is in the form of a film that adheres to the surrounding tissue, and some of the tumors can be seen as substantial or calcified. If the tumor is small or located in the pituitary, the tumor wall can be peeled off as much as possible and the tumor removed. If the tumor is large, the wall of the tumor often adheres to the surrounding dura mater and saddle. The entire sella is almost completely occupied by the tumor sac, or the saddle is seen from the saddle to penetrate the saddle and extend over the saddle. After the cyst fluid is emptied, it can be seen that the parenchyma and the calcified tumor are tightly attached to the wall of the capsule, and only a slight removal can be achieved. The tumor cyst is not filled, and the saddle bottom bone window is not repaired, so that the cyst fluid flows into the sphenoid sinus when the tumor recurs. Laws (1980) also advocated the insertion of a small silicone tube into the tumor cavity, the other end placed in the sphenoid sinus or buried under the mucosa of the nasal septum to facilitate drainage to the sphenoid sinus and nasal cavity. During the operation, the upper part of the saddle should not be peeled off excessively, so as not to tear the arachnoid membrane on the saddle to make the cerebrospinal fluid flow into the tumor cavity. Once this happens, the tumor cavity must be filled with muscle blocks or fat, and the saddle bottom bone window is repaired to avoid cerebrospinal fluid rhinorrhea. However, after tamponade and repair, once the tumor recurs, other treatments need to be considered. complication 1. Visual impairment. 2. Diabetes insipidus. 3. Pituitary dysfunction. 4. Symptoms of hypothalamic damage.