I. Overview
Craniopharyngioma is a common embryonic remnant tissue tumor that develops from the epithelial cells of the remnants of the craniopharyngeal tube formed by the ectoderm, and is the most common intracranial congenital tumor, note that it is a benign tumor ah. It is most common in children, and less common in adults, and is most likely to occur in the suprasellar region. Its main clinical features include hypothalamic-pituitary dysfunction, increased intracranial pressure, visual acuity and visual field disorders, uveitis, and neurological and psychiatric symptoms. Treatment is mainly surgical removal of the tumor.
Question 1: Why does craniopharyngioma itself cause symptoms such as hydrocephalus, uveitis or loss of vision?
Craniopharyngioma occurs at the site of the pituitary stalk, precisely in the pituitary gland, the optic nerve, and the pharyngeal gateway to the hydrocephalus pathway. Because craniopharyngioma is a tumor from the endocrine center of pituitary gland, it does not cause hydrocephalus, urinary collapse or vision changes by itself, but when the tumor grows and compresses the optic nerve and optic cross, it will produce vision changes, and secondly, the tumor grows up to the saddle and compresses the base of the three ventricles, causing obstruction of cerebrospinal fluid return, which is what produces obstructive hydrocephalus. In some patients, when the tumor compresses the paraventricular nucleus of the supraoptic nucleus of the pituitary gland, it will produce water-electrolyte disorders and lead to urocephalus symptoms. Therefore, patients should be highly alert to the tendency of tumor enlargement when the above symptoms appear.
Question 2: Can craniopharyngioma resection also cause complications such as hydrocephalus, uveitis or vision loss? If these symptoms existed before the surgery, will the surgery aggravate these symptoms?
Post-operative craniopharyngioma surgery usually causes hydrocephalus, urinary collapse or loss of vision when the surgery damages the appropriate structures. Patients who have symptoms before surgery may experience varying degrees of improvement after surgery, especially in the long-term prognosis.
Question 3: After craniopharyngioma surgery, how long will it take for the patient’s hydrocephalus and other neurological compression symptoms to resolve until they disappear?
Hydrocephalus will be significantly relieved after surgery, but imaging improvement takes a period of time usually six months to one year, vision improvement usually within a few days after surgery, and improvement of uveitis will take longer.
Question 4: Can vision return to normal after craniopharyngioma surgery? How long does it take to get better?
If the loss of vision is within a short time before surgery, vision will return quickly after surgery. It usually takes six months or longer for the nerve function to recover.
Question 5: Will complications caused by the surgery resolve or disappear on their own with time? Do they need to be treated?
Complications caused by surgery include water-electrolyte disorders, abnormal hormone metabolism and other neurological dysfunctions, which usually gradually improve with treatment within one to two weeks after surgery, sometimes requiring periodic review. For hormonal abnormalities, some episodes require lifelong hormonal medication as a substitute.
Question 6: Do I need hormone therapy for the recovery of endocrine function after craniopharyngioma surgery? Do I need to see an endocrinologist for hormone adjustment?
This is certainly an area in which endocrinologists are more specialized, and abnormalities that cause hormonal regulation usually require hormonal compensation.
Question 7: How should I be reviewed after surgery? What are the items that need to be reviewed? Do I need to review cranial imaging and blood biochemical tests?
Generally, after craniopharyngioma surgery, blood biochemical sodium and potassium ions, as well as hormone levels need to be checked regularly, daily for 1-2 weeks after surgery, and hormone levels for half a month-1 month after surgery, and any abnormal changes need to be supplemented in time. The MRI of the head should be checked at 3 months, 6 months and 1 year after surgery, and the scan should be enhanced to observe the changes of the tumor after surgery, and the recurrence should be treated again.
Prognosis of children and adults after craniopharyngioma surgery
The first point is that craniopharyngioma is a benign tumor, and according to oncological analysis, it will not affect the life quickly and will not affect the patient’s quality of life as long as the tumor does not grow.
In the past, the surgical total resection rate of this tumor was low, and the death and disability rate and recurrence rate were high. In recent 30 years, microsurgery has been carried out to protect normal brain tissues, fight for total resection of tumor, reduce damage to hypothalamus and pituitary gland, reduce disability and mortality rate, and greatly improve the prognosis of patients. The operative mortality rate of craniopharyngioma has been reduced to 2%, the 10-year survival rate is 58%-66%, and the recurrence rate is 7%-26.5%. In recent years, it is still developing to be better.
Therefore, here we hope that we can treat craniopharyngioma with a positive attitude and give each patient the most comprehensive treatment.