Introduction to Craniopharyngioma Summary: Craniopharyngioma is a benign congenital tumor that occurs from the remnant tissue of the craniopharyngiopharyngeal tube during embryonic life. Incidence Craniopharyngioma accounts for about 4% of intracranial tumors. However, it is the most common congenital tumor in children, accounting for the first place of saddle region tumors. So, what is craniopharyngioma? In this article, we will introduce craniopharyngioma from the overview, clinical manifestations, etiology and other aspects in detail. I. Overview of craniopharyngioma Craniopharyngioma is a benign congenital tumor, which occurs from the residual tissue of craniopharyngeal tube in embryonic period. Incidence of craniopharyngioma accounts for about 4% of intracranial tumors. However, in children it is the most common congenital tumor, accounting for the first place of tumors in the saddle region. It can occur at any age, but 70% occur in children and adolescents under 15 years of age. Craniopharyngioma, also known as pituitary tubular tumor, is a benign congenital tumor that occurs in the residual tissue of the craniopharyngioma during embryonic period, accounting for about 4% of intracranial tumors and the first tumor in the saddle region, with the peak of incidence at the age of 15 years or 13 years. Most of the tumors are located in the suprasaddle region, and may develop in the direction of the third ventricle, hypothalamus, inter-foot pools, pars pallidus, both temporal lobes, the bottom of frontal lobe, and in the saddle, etc. They compress the optic nerves and optic crossings, and obstruct the cerebrospinal fluid circulation and lead to hydrocephalus. Clinical manifestations of craniopharyngioma Symptoms and signs The main manifestations include visual impairment, visual field defect, dysuria, obesity, developmental delay and so on. Adult males have sexual dysfunction and females have menstrual irregularities. There may be increased intracranial pressure in the late stage. 1. Symptoms of increased intracranial pressure are usually due to the development of the tumor toward the saddle involving the anterior half of the third ventricle. Occlusion of the interventricular foramen leads to hydrocephalus. 2.Impaired visual field, caused by the tumor located on the saddle compressing the optic nerve, optic cross and optic bundle. 3.Hypopituitarism, the tumor compresses the anterior pituitary gland, leading to the growth and developmental disorders manifested by the insufficient secretion of growth hormone and gonadotropin, and adults may have hypogonadism, amenorrhea, and so on. 4, the performance of hypothalamic damage: the tumor to the saddle development of hypothalamic compression can be manifested as hypothermia, lethargy, uremia and obesity reproductive impotence syndrome. Craniopharyngioma is a congenital tumor, which is more common in children and adolescents, and is more common in males than females. Most of the tumors are located in the suprasaddle region, and may develop in the direction of the third ventricle, hypothalamus, inter-foot pool, pars pallidus, both temporal lobes, frontal lobe base and in the saddle, etc. The tumor may compress the optic nerves and optic nerve crossings, and obstruct the cerebrospinal fluid circulation and lead to hydrocephalus. Pathophysiology of craniopharyngioma: Most of the tumors are located in the suprasellar region, and may develop in the direction of the third ventricle, hypothalamus, interphalangeal pool, pars pallidus, both sides of temporal lobe, frontal lobe base and in the in-saddle, etc. The tumors may compress the optic nerves and optic crossings, and cause hydrocephalus due to the blockage of cerebrospinal fluid circulation. Most of the tumors are cystic, with yellowish brown or dark brown cystic fluid containing a large number of cholesterol crystals. There are calcified plaques on the tumor wall. Under the microscope, the tumor cells were mainly composed of squamous or columnar epithelial cells, and some of them were arranged into tooth enamel organ-like structure. Treatment of craniopharyngioma is mainly based on surgical resection. Early diagnosis, the use of microsurgical techniques, striving for the first total surgical resection, strengthening hormone replacement therapy and postoperative monitoring are important to improve the therapeutic efficacy. Due to the close adhesion of the tumor to the hypothalamus and the important surrounding neurovascular vessels, total resection is sometimes difficult. Some people advocate intracystic drainage via lateral ventricle, or injection of radioactive phosphorus or gold after cyst aspiration for internal radiation therapy. Sixth, the treatment of craniopharyngioma 1, surgical resection: feasible total excision or subtotal excision, but the tumor and the internal carotid artery, optic nerve and other peripheral tissues are closely connected and the infiltration of large tumors on the surrounding tissues, the effect is often unsatisfactory, the recurrence rate is high, and prone to produce hypothalamic damage caused by uremia, temperature dysregulation, aseptic meningitis. The improvement of symptoms after surgery is also unsatisfactory. 2.Head gamma knife treatment: Gamma knife treatment for craniopharyngioma is a very mature technology, because of the precision of gamma knife treatment, so it can seldom hurt the normal tissues around the tumor. For tumors with cystic changes, the cystic fluid can be punctured after gamma knife treatment. 3.Chinese medicine treatment: Anti-tumor positive brain series of matching application is suitable for patients who have not undergone surgery or partial resection by surgery, postoperative recurrence, X-knife, γ-knife, after radiotherapy, patients can eliminate the symptoms with medicine for about 3 months, so that the tumor shrinks or disappears, and surgical use of medicine can eliminate the residual tumors, and prevent the recurrence of the tumor, and the therapeutic effect is exact in clinical application for many years. Pre- and post-surgical care of craniopharyngioma Pre-operative care of craniopharyngioma 1. Psychological care: craniopharyngioma mostly occurs in children and young people, their psychological tolerance is poor, and once diagnosed, the psychological burden is very heavy, and it is easy to produce fear and pessimism. In addition, craniotomy has a certain degree of danger, patients often feel uneasy, afraid and irritable, affecting rest and sleep, and even refusing surgery. For this reason, nurses should patiently answer all kinds of questions from patients, relieve patients’ worries, and introduce successful cases to establish patients’ confidence in overcoming diseases. Evaluation of vision and visual field: Craniopharyngioma directly compresses the optic nerve, optic cross and optic bundle, 70-80% of the patients have visual acuity and visual field disorders. Nurses can understand the patients’ visual acuity and visual field through rough measurement, the specific method: let the patients look ahead, use the fingers to move in the upper, lower, left and right directions at equal distances to check the patients’ visual field. At different distances in front of the patient (e.g., 1 m, 2 m, 3 m, etc.), the visual acuity was assessed with the index of the hand and recorded for comparison with the postoperative visual acuity. 3, the observation of hypothalamic damage, craniopharyngioma develops to the saddle and increases to the bottom of the third ventricle, the hypothalamus is compressed, and the result of this may appear uremia, high fever, coma and other symptoms, with uremia being the most common, record the patient’s preoperative urine volume for 3 days, and provide a numerical basis for the observation of uremia in the postoperative period. Postoperative care of craniopharyngioma 1.Observation of hypothalamic damage As craniopharyngioma surgery has different degrees of damage to hypothalamus, it is easy to cause urinary avalanches and hydroelectrolyte disorders. Accurately record the change of urine volume per unit time, observe the color of urine, and measure the specific gravity of urine if necessary. Follow the doctor’s advice to take blood specimen at regular intervals for blood biochemistry examination. When the urine volume per hour is less than 250ml, it can be left untreated for the time being and continue to be observed. When the hourly urine volume is 350～450 m1 and the blood electrolytes are normal, use 2～6 U of posterior pituitary hormone according to the patient’s age and body weight.When the hourly urine volume is 450～550 ml, give rehydration fluids according to the blood electrolytes. If the blood sodium is more than 145 mmol/L, patients with clear consciousness can take oral rehydration with plain water to promote the discharge of blood sodium and prevent water loss; patients who cannot eat are injected with plain water through indwelling gastric tube. When the patient’s blood sodium is less than 135 mmol/L, oral rehydration salts or saline is given. 2.Assessment of consciousness Postoperative intracranial hematoma, electrolyte disorders caused by coma, low levels of hormones in the body is the main reason for the change of consciousness in craniopharyngioma. If the change of consciousness is sudden and accompanied by elevated blood pressure, rapid pulse and unequal pupil size, the change of intracranial pressure should be considered firstly, and the doctor should be reminded to perform CT examination. If the impaired consciousness is progressive and there are electrolyte changes, blood specimen should be taken immediately for urgent blood biochemistry examination. If the blood biochemistry is normal and the patient has clinical symptoms such as fatigue, it may be that the hormone supplementation is insufficient or the hormone is reduced too quickly, resulting in low hormone levels. In conclusion, when the patient has consciousness disorder, the nurse should assess the cause according to the data from various aspects, and report to the doctor in time, and actively cooperate with the resuscitation. 3, vision, visual field observation Preoperative has been recorded on the patient’s visual field of vision, visual field should be evaluated again after surgery to grasp the intracranial changes after surgery, usually in the patient’s postoperative mental status is good to check, if the visual field of vision than the preoperative decline, usually due to surgical damages; if sudden changes, consider whether intracranial hemorrhage, notify the doctor in time to make a treatment. 4. Observation of pupil and vital signs The change of pupil is often earlier than the change of vital signs, so we must strengthen the observation of bilateral pupil size, morphology and response to light after surgery, and report to the doctor in time if there is any abnormality. Continuous electrocardiographic monitoring should be given and recorded every 15-30 min until the condition stabilizes. The gradual increase of blood pressure and the formation of hypertension often suggests intracranial hypertension; slow and strong pulse suggests that the intracranial pressure has a tendency to increase, and fast and weak indicates that the effective blood volume is insufficient; irregular respiratory rate, shallow and shallow suggests that the respiratory center is impaired; elevated temperature suggests that there is central hyperthermia or infectious hyperthermia or dysfunction of the thermoregulatory center, such as hypothermia, cold limbs, suggesting that there is a possibility of shock. 5, position and drainage tube care The patient is conscious, blood pressure is stable, take the head elevated 15-30 degrees slope position, in order to facilitate blood reflux, reduce intracranial pressure, keep the drainage tube unobstructed, the patient’s head to do appropriate restrictions, in the turning, treatment and other injuries operation, the action is gentle, slow, small angle, do not pull the drainage tube, to prevent the drainage tube pull off. Check whether the drainage tube is pressurized, twisted or angled at any time, and deal with the problem in time. Change the drainage bottle and surgical site dressing under aseptic operation every day, and pay attention to the amount, color and character of the drainage fluid.