07:24,4,May,2012 | (297/0/0) | Original

craniopharyngioma hypothalamus

Cited reference】 【with China Academic Journal ago 10 1 Xu Jianguo, Chao, Zhu C, Cai Bowen, He Min, Wang Shu; craniopharyngioma efficacy and treatment options [J]; Chinese Journal of Clinical Neurosurgery ; 2005 04 2 Zhang Yuqi, Wang Zhongcheng, Ma Zhenyu, Luo Shiqi, A Ge, Xing Jian, Xie Jian; children craniopharyngioma surgery and long-term follow-up [J]; Journal of Neurosurgery; 3 Shixiang En 2005, 09, Zhang force, Zhouzhong Qing, Liu Bo; Surgical treatment of recurrent craniopharyngiomas [J]; Journal of Surgery; 2004 13 4 Zhang Yuqi! 100050, Zhongcheng! 100050, Ma Zhenyu! 100050; children, 189 patients with craniopharyngioma analysis [J]; Journal of Medicine; 2000 04 5 Chen shape, paint Greenfield, Fanglu Xiong, Pan Jun, Dai Xuejun; Craniopharyngioma MRI and postoperative performance between water and sodium metabolism of [J]; Chinese Journal of Invasive Neurosurgery; 2004 01 6 Wang Yihua, paint Greenfield; diabetes insipidus and pituitary stalk damage in [J]; of Minimally Invasive Neurosurgery; 2005 01 7 Pan Jun, paint Greenfield, Zhang Jialin, Fang Lu Xiong, Peng Lin; craniopharyngioma on hypothalamic structure and clinical significance of invasion of way [J]; Guangdong Medicine; 8, 2003, 12 Xiaoyun, Zhu Xiaoli, Geng Daoying, Shen naive; craniopharyngioma pathology and MRI Comparative analysis [J]; China Medical Imaging Technology; 2002 03 9 Ge Gangfeng; pituitary gland and its significance in the form of funnel [J]; Zhejiang Medicine; 1998 09 10 Liaojian Chun, Shi small Tian, Shi Ming, Fan Jingping , Lu Shuchang; pituitary saddle diaphragm holes with Microsurgical anatomy and clinical significance [J]; Anatomic; 1998 02
craniopharyngioma hypothalamus

Basic overview of the craniopharyngioma is a benign congenital tumor, craniopharyngioma tube from embryonic remnants of the group
Occurrence of symptoms of craniopharyngioma organization. Incidence of craniopharyngioma about 4% of intracranial tumors. However, in children is the most common congenital tumors, accounting for the first sellar tumor. The disease can occur at any age, but 70% are 15 years of age in children and adolescents. Pituitary craniopharyngioma also known as the tumor is the embryonic remnant of the cranial pharyngeal canal benign congenital tumor tissue, representing about 4% of intracranial tumors, accounting for the first sellar tumor, the incidence peak of 15 years of age or 13-year-old, female slightly more than men. Prevention: early detection, early diagnosis and early treatment. Cause of the disease as congenital diseases, slow growth. During normal embryonic development, Rathke pouch attached to the original oral
The slender tube that is connected craniopharyngioma craniopharyngioma tube, the tube with the embryonic development and gradually disappear. Rathke pouch remnants of the anterior wall of the former Ministry of leaf nodules, de
gradation of the remnants of the cranial pharyngeal squamous cell tube may be the origin of craniopharyngioma occurred. So craniopharyngioma can occur in the pharynx, sphenoid sinus, saddle, the saddle and the third ventricle, and some can invade the posterior fossa. Most of the buccal tube Craniopharyngioma originated in the cranial infundibulum close to the remnants of squamous epithelial cells, it is the tumor located in the saddle, forming the so-called "saddle type" craniopharyngioma; few tumor originated in the middle of the remnants of the Ministry of cells, then tumor located in the saddle, which formed the so-called "saddle the type" craniopharyngioma. Part of the craniopharyngioma and saddle in the saddle in all, the tumors were dumbbell-shaped. Described as a congenital disease, cancer, accounting for 5% of intracranial tumors. More common in children and adolescents, more men than women. Mostly located in the suprasellar region tumors can be made to the third ventricle, hypothalamus, between the foot pool, parasellar, both sides of the temporal lobe, frontal lobe and saddle the other end of
Direction causes disease, optic nerve and optic chiasm compression, obstruction of cerebrospinal fluid circulation caused by hydrocephalus. Symptoms and signs mainly with visual impairments, visual field defect, diabetes insipidus, obesity, developmental delay. Adult male sexual dysfunction, women have irregular menstruation. Late may have increased intracranial pressure. Signs and symptoms of craniopharyngioma can be seen at any age, but most see the 6 to 14 years. Most of craniopharyngioma is intermittent
Pathogenesis of craniopharyngioma growth, so the whole slow tumor growth, slow development of their symptoms; few craniopharyngioma rapid growth, the progress of the disease is also faster. Clinical manifestations include the following: the tumor mass effect and obstruction room high intracranial pressure caused by inter-hole performance; tumor compression optic chiasm, optic nerve caused by visual impairment; tumor compression of hypothalamus and pituitary causes of the hypothalamus - pituitary dysfunction ; tumors and other brain tissue caused by invasion of the nerve, mental symptoms. Mainly in the following five areas: 1. Craniopharyngioma increased intracranial pressure performance of larger, as intracranial space occupying lesion, which can be directly caused by mass effect, intracranial hypertension. Craniopharyngiomas can oppress the third ventricle, blocking holes leaving room between intracranial pressure and intracranial pressure which may cause their main reason. Symptoms of increased intracranial pressure more common in children, the most common were headache, you can re-light, more than occurred early in the morning, accompanied by vomiting, tinnitus, vertigo, photophobia, optic disc edema, abducens nerve palsy, also may have fever , facial flushing, sweating and other autonomic dysfunction performance. After more than a headache in the orbital, but also diffuse to the neck, back radiation. Suture closure in children are not separated prior to the bone joints, head circumference increased, percussion sound was broken pot, scalp vein engorgement and so on. Cause of intracranial hypertension were mostly large cysts, tumor compression third ventricle, between the holes can also be caused by blocked rooms obstructive hydrocephalus. Because cysts are free to change the internal pressure, sometimes to automatically relieve symptoms of intracranial hypertension. Occasionally, intratumoral cyst rupture, cyst fluid spill into subarachnoid space can cause chemical meningitis and arachnoiditis, expressed as sudden severe headache, vomiting, meningeal irritation with symptoms such as neck resistance, Kening sign positive, cerebrospinal fluid of leukocytosis, fever and so on. Late can cause increased intracranial pressure coma. 2. Optic nerve compression showed the performance of visual acuity, visual field changes and fundus changes. Saddle on the type of tumor growth direction because of pressure caused no fixed rules in different parts, so that a large variation of visual field defect, for the quadrant of the defects, hemianopia, dark points. Tumors can cause visual field defects optic chiasm compression, common to the two temporal hemianopsia, such as see the dual nature of the temporal inferior quadrant hemianopia, suggesting that pressure from the top down, both sides of the extent of the damage can be inconsistent. If only the oppressive side of the optic tract tumors, generates the same to the hemianopia. If the severe oppression of the optic chiasm tumor, can cause primary optic atrophy; such as tumor invasion of the third ventricle, causing hydrocephalus and increased intracranial pressure, may be of secondary optic atrophy. Ocular motor nerve can be affected, resulting in double vision and other symptoms. Intrasellar tumor of the optic chiasm compression from the bottom up, producing the same visual field defects and pituitary tumors, vision loss and optic atrophy. Sometimes due to hemorrhage at the optic chiasm infarction, sudden blindness Erzhi blood circulation disorders. Had primary optic atrophy optic disc edema rarely happen again. Tumor growth can be generated to the side of the Foster-Kennedy syndrome. Early visual field defects in children does not cause much attention until a serious obstacle to vision only to be found. 3. Craniopharyngioma symptoms hypothalamus hypothalamus and pituitary suppression can cause a variety of endocrine and metabolic disorders and hypothalamic dysfunction: cancer or nerve damage to the pituitary as the nucleus, can cause diabetes insipidus, the occurrence rate of about 20%; tumor invasion and hypothalamic thirst center polydipsia can cause the patient to drink or loss of thirst; tumor invasion and satiety center, which can cause more food or anorexia; tumor invasion and body temperature regulation center, may include fever; loss and pituitary tumor portal system or direct invasion and pituitary dysfunction can be caused by pituitary tumor destruction of hypothalamic TRH, CRH, GnRH neurons can be induced, respectively, TSH, ACTH, and gonadotropin deficiency; tumor suppressor loss and hypothalamic neurons pituitary gland can cause hyperthyroidism, a common expression of sexual precocity, acromegaly, skin pigmentation deepened Cushing disorder; some patients with obesity, lethargy, mental disorders, vasomotor dysfunction and other symptoms. (1) obesity sexual reproductive incompetence syndrome: management of the hypothalamus tuberalis sexual function and reproductive activities, and has always been through the completion of anterior pituitary gonadotropin; infundibulum and tuber cinereum area and fat metabolism. The parts of the compression and destruction, can produce clinically obese, children sex organs are not developed, adult sexual desire disappears, women's menopause, lactation disorders, secondary sexual characteristics disappeared. (2) body temperature regulation disorders: clinical and more damage to the rear of the hypothalamus showed a lower body temperature (35 ℃ ~ 36 ℃), a small number of patients may have chills phenomenon; anterior hypothalamus can cause the affected central high fever (39 ℃ ~ 40 ℃). (3) diabetes insipidus: urine output showed an increase, up to thousands a day or 10000ml ml or more, so drink lots of water, children's beds at night easily drowned. Diabetes insipidus due to tumor injury supraoptic nucleus, paraventricular nucleus, hypothalamus - pituitary neurohypophysis induced beam or antidiuretic hormone (ADH) secretion decreased or lack of, but polyuria and normal secretion of ACTH, such as the anterior pituitary also damaged, ACTH secretion decreased, the collapse will not produce urine. Sometimes due to hypothalamic thirst center also destroyed, you can have decreased thirst syndrome with diabetes insipidus, although diabetes insipidus patients, the plasma state of high permeability, but no thirst. Forbidden to drink urine osmolality at the time does not rise or rise slightly, hypovolemia, hypernatremia syndrome. Patients can produce headache, tachycardia, irritability, blurred consciousness, delirium or even coma, sometimes seizures can produce hypotension. (4) lethargy: seen in advanced cases, the light can still wake up, severe sleep all day. (5) psychiatric symptoms: such as forgetfulness, inability to concentrate, fiction, etc., and hypothalamus - hypothalamus limbic system or frontal lobe damage on contact, adults were more common. (6), bulimia or poor feeding disorders: the hypothalamic ventromedial nucleus of the satiety center damage may have bulimia (obese patients), ventral lateral nucleus of the preferable center may have anorexia or poor feeding damage symptoms (patient weight loss). Clinical less likely to see. (7) High prolactin (PRL) viremia: a few cases of tumor in the hypothalamus or the pituitary stalk, causing prolactin inhibitory factor (PIF) secretion decreased secretion of pituitary PRL cells, can produce clinical galactorrhea - amenorrhea syndrome. (8) to promote the loss of pituitary hormone secretion: hypothalamic affected can lead to GHRH, TRH, CRH secretion in the loss of growth and clinical manifestations of thyroid, adrenal dysfunction. 4. Pituitary dysfunction, pituitary dysfunction, symptoms of pituitary hyperfunction more common, especially in LH / FSH and GH lack of more common. About 50% of children with growth delay, about 10% of the children with short stature apparent sexual hypoplasia. The performance of adult patients with GH deficiency is not outstanding, but sexual dysfunction in 30%. TSH deficiency causes secondary hypothyroidism met on 1 / 4 of the patients, ACTH deficiency causes secondary adrenal insufficiency is not rare. Lack of pituitary function in children who showed early physical growth retardation, body short, thin, weary and easy fatigue, reduced activity, smooth pale skin, pale yellow and wrinkled, looks like old age. Stop the development of teeth and bone, joint or bone is not delayed union was infantile sex organs, no secondary sex characteristics, also showed no testis Syndrome-class. A few may have cold, mild mucous edema, low blood pressure, and even those who were Simmond cachexia. Adult women have menstrual disorders or menopause, infertility and premature aging phenomenon. Males were found loss of libido, hair loss, low blood pressure, low metabolism (up to 35%) and so on. 5. To the surrounding neighborhood can be symptoms of cancer growth, such as to both sides of the growth, invasion of the temporal lobe, temporal lobe epilepsy can cause. Downward extension of tumor, and brain invasion feet, can produce spastic paralysis, or even to the brain tonic state. Some patients may suffer from mental disorders, manifested as memory loss and even loss, apathy, blurred consciousness, or severe dementia. Such as the growth of the parasellar cavernous sinus syndrome may have caused Ⅲ, Ⅳ, Ⅵ cranial nerve disorders; to the sphenoid sinus, ethmoid growth may cause nose bleeding, cerebrospinal fluid leak; to the growth of the anterior cranial fossa may produce psychotic symptoms, such as memory loss, poor orientation, urine can not take care of themselves, as well as epilepsy, olfactory disorders; to the growth of the middle cranial fossa may have temporal lobe epilepsy and magic smell, taste and other psychiatric symptoms magic; a small number of patients, the tumor can be back the growth of the brain stem symptoms, even to the posterior fossa caused by long-cerebellar symptoms. Small number of patients olfactory nerve and facial nerve may also be involved, showing the sense of smell loss and facial paralysis. All of the above symptoms in children and young adult patients and patients with a slightly different frequency, the former first symptom of intracranial hypertension more common, the latter more common symptoms of optic nerve compression, all patients had endocrine changes that may arise, but the adults found earlier. Clinical manifestations 1. Symptoms of increased intracranial pressure, usually due to tumor involvement of the saddle on the development of the first half of the third ventricle. Occlusive hydrocephalus room due to inter-hole lead. 2. Acuity vision disorders, tumors located in the saddle on the oppression of the optic nerve, optic chiasm, optic tract due. 3. Hypopituitarism, tumor suppression and gonadotropin secretion in anterior pituitary hormone deficiency caused by the performance of the barriers to growth and development, adult, sexual dysfunction, amenorrhea. 4. The performance of hypothalamic damage: the development of the tumor on the hypothalamus to the saddle can be expressed as a temperature of low pressure, lethargy, obesity, diabetes insipidus and syndrome of reproductive incompetence. Pathophysiology 1. Pathogenesis of craniopharyngioma tissue, there are two more common doctrine of being accepted. (1) The theory of congenital left: This is one more widely accepted theory of tissue. Erdheim the first nodules were observed in normal pituitary Department has remnants of squamous epithelial cells, that originated in the residual craniopharyngioma epithelial cells. In the embryonic period of 2 weeks of oral top up the original formation processes of a deep blind bags, known as Rathke bag, with further development, Rathke bag was fine under the narrower the tube, that is called the tube or craniopharyngioma pituitary control. Under normal circumstances, the embryos 7 to 8 weeks craniopharyngioma tube that gradually disappeared during the development of epithelial cells in small nests are often left behind, that is, a craniopharyngioma tissue of origin. (2) squamous metaplasia theory: Luse and Kernohan 1955, observed 1364 cases of autopsy of the pituitary gland and found that only 24% of squamous cell nests, which appeared the growth rate increased with age, 20 years of age occurrence rate of squamous cell nests is very low, so they think that squamous cell metaplasia nest is a product of the pituitary, rather than embryonic residues. There was also observed in pituitary gland cells and squamous cell hybrid, and between the two over to see the findings also support the metaplasia theory. 2. Pathologic changes generally larger size of craniopharyngioma, the tumor often has spherical shape, irregular, or nodular growth and expansion, no envelope, clear boundaries, scope, size differences are significant, mostly multilocular cystic-like or part of the cystic, a small number of substantive, with only a few small cysts. Gray red tumor, cyst fluid can be yellow, brown, brown or colorless. Such as cyst rupture, cyst fluid overflow, which can cause meningitis and arachnoiditis. Cystic among those in the saddle, and often in a substantial part of the Department of cystic above the wall surface is smooth, the thickness ranging from thin may as translucent gray or brown on many calcifications or calcified plaque, and shell-like ossification was available, the contents of the capsule epithelial cell degeneration and liquefaction of the debris (keratin-like material), or cyst fluid was yellow oil-like liquid, floating cholesterol crystals embedded flash, generally 10 ~ 30ml, more by up to 100ml or more. After the tumor is usually located under the Ministry of substance, nodular, containing calcification, sometimes compact and hard, often with major intracranial blood vessels, pituitary stalk, and the third ventricle, as the Road Department and other tight adhesion and the structure of oppression. Brain tumors can also cause the formation of the glial reaction with pseudocapsule, and sometimes broke into the hypothalamus were papillary, surgery may cause distraction hypothalamus tumor injury. Within solid tumors were located in the saddle or the third ventricle, the volume is smaller than those of cystic. Tumor shape can be divided into enamel-and squamous papillary type two. Enamel type more common, occurring mainly in children. This type of the outermost layer of columnar epithelial cells, gradually shifting to the center of the outer layer was fence-like behavior, and the inner cells of the stellate cells arranged loosely. Tumors often degeneration, hyperkeratosis and small cysts, after capsule formation of exfoliated cells absorb calcium scattered calcification as many salient features of craniopharyngioma, almost all of craniopharyngioma can be seen in the microscopic calcification, Most cases can be found in the radiographic calcification. Craniopharyngioma often extended into the adjacent brain tissue papillae (particularly the hypothalamus), making the tumor and the brain are closely linked, it is often difficult to completely strip the surgery. Squamous papillary squamous epithelium by the well-differentiated cells, which are rich in fiber every vascular matrix, cell envelope of natural crack or split and the formation of the lesion prominent pseudopapillary, the general type of keratosis without enamel beads, calcification , inflammatory response and cholesterol deposition, this type of mostly solid tumors. Craniopharyngioma occasional reports rapid growth, recurrence was invasive, but most scholars do not think that is the malignant transformation, some of the performance of electron microscopy with anaplastic tumors, in tissue culture despite the tendency of encysted, but almost no mitotic activity. Craniopharyngioma occur because parts of the blood supply differ, saddle on the tumor blood supply from anterior circulation of the small ring Wi1lis arteries, but also that there directly from the carotid artery, posterior communicating artery blood supply. But does not accept craniopharyngioma from posterior cerebral artery (or basilar artery) blood supply, unless the tumor blood vessels close to the bottom of the third ventricle. Intrasellar tumor blood supply from the cavernous internal carotid artery through a small artery. Tumor growth may compress the optic nerve to the surrounding cross, pituitary gland, the bottom of the third ventricle, hypothalamus, or even block one or both sides of the room between the holes caused by obstructive hydrocephalus. Intrasellar tumor of mostly substantive, smaller, earlier limited to the intrasellar pituitary direct pressure, after the upward growth can affect the optic nerve, chiasm and third ventricle. Diagnosis for patients diagnosed at any age, such as with high intracranial pressure, neurological eye symptoms and the hypothalamus - pituitary tangled
Craniopharyngioma should be considered diagnostic of possible chaos. According to the predilection sites, clinical manifestations and diagnosis of craniopharyngioma is not difficult to assist. Where young children are endocrine disorders, such as the development of short stature, polydipsia and polyuria, obesity, genital hypoplasia, etc., should first consider the disease; if the saddle or saddle-calcified plaque, and help diagnosis. If adult sexual dysfunction or headaches, visual field of vision disorders, the disease should also be considered. Those who are not typical of a small number of clinical manifestations, clinical diagnosis of mild symptoms are easy, the key is to increase the vigilance of this disease. Through laboratory tests, CT and MRI in the diagnosis of great significance, for suspected cases of such checks should be done promptly to avoid delay in diagnosis. Laboratory tests: general no special laboratory tests. Endocrine function test most patients, there may be delays glucose tolerance curve low and flat or falling, blood T3, T4, FSH, LH, GH and other hormones decline. Showed a small number of pituitary hyperfunction, most showed varying degrees of pituitary gland dysfunction and the corresponding target. 1. Growth hormone (GH) and GH stimulation test measured serum GH value decreased craniopharyngioma, and to insulin hypoglycemia, arginine, L-dopa stimulation test, etc., no response was significantly increased, accounting for 66.7% . 2. Gonadotropin (GnH) HMG (FSH), luteinizing hormone (LH) stimulation test measuring and GnH. Craniopharyngioma serum FSH, LH levels decreased, and on the gonadotropin-releasing hormone (used for 3. Prolactin (PRL) serum PRL levels measured can be increased, this may be due to tumor blockage of the PRL release inhibiting hormone (PIH) into the pituitary, the PRL secretion and release, can cause galactorrhea, amenorrhea. accounted for 50%. 4. promote the gland on the adrenal cortex hormone ACTH, TSH thyroid stimulating hormone measurement as a serious oppression pituitary tumor shrink, the patient serum ACTH, TSH decreased. 5. antidiuretic hormone (ADH) ADH measured in patients with craniopharyngioma often reduced. 6. lumbar puncture who have increased intracranial pressure, hypertension may occur lumbar puncture test and cerebrospinal fluid tests no more than change. Other auxiliary examination 1. skull X-ray 80% to 90% of patients had skull X-ray abnormality. children have abnormal skull plain film
Identification of similar changes in disease account for 94%, 60% adults. The main difference usually presents the following three aspects. (1) tumor calcification: calcified craniopharyngioma a variety of forms, as the salient features of craniopharyngioma, saddle and saddle on the type of tumor are calcifications within the type, while the other saddle very rare lesion calcification (calcification rate than 1% or less). Calcification in children than adults in common, children with craniopharyngioma calcification rate of 70% to 85%, 2 years of age accounted for 20% of children older than 2 years accounted for 80% of calcium, more than 15 years of age accounted for 50% of adults about 35%. Children intrasellar calcification should be highly considered for craniopharyngioma. Calcification can be very flexible, can be dispersed, but also together, and sometimes were bent like thin. Calcification often appears in the midline area, occasional larger lesions can be limited to the surrounding part of the calcification. 60% ~ 81% of the patients experienced tumor calcified plaque, was single or scattered like, can also be integrated into a shell-like. (2) sella change: Children patients due to the lack of TSH and GH, and bone X-ray can show bone age decreased. Sellar craniopharyngioma in the upper part of the vast majority can oppress sella down, so the skull can be found on the plain film become flat sella, clinoid damaged. Craniopharyngioma in the saddle a small number within the chip level can be seen in the skull to expand the sella turcica. Virtually any type of change can be seen in sellar craniopharyngioma, is typical of the saddle can be changed on the tumor, the tumor can also be a change in the saddle. 35% of the patients was basin-shaped or spherical sellar enlargement or destruction, and the saddle back after clinoid can be sharpened, decalcified, disappeared. Sella change significantly, often prompted a huge lesions, otherwise not. (3) signs of intracranial hypertension: 60% of patients on the skull X-ray shows signs of increased intracranial pressure, showing saddle back decalcified skull back pressure within the board trace apparent brain, skull base variable equal performance, children can a separation of the skull sutures. 2.CT CT scan showed brain scans as a sellar tumor changes were solid tumors of non-enhanced scan showed high density, density or other images, calcified plaque for the high-density, cystic tumors were included because, like cholesterol and low density , CT value -40 ~ 10Hu, cystic isodense. Lesion with clear boundary, were round, oval or lobulated, both sides of the lateral expansion of the Division. Enhanced scan in about 2 / 3 of the cases can have different degrees of enhancement, CT values increased 12 ~ 14Hu, cystic craniopharyngioma showed ring enhancement or ring enhancement and central low density area without enhancement, a few tubes craniopharyngioma tumor is not enhanced. Generally have calcification, cysts, and strengthened the performance of enhanced three sellar tumors. Differential diagnosis with high intracranial pressure as the main manifestation of craniopharyngioma needs and identify other intracranial space-occupying lesions; to visual acuity, visual field change the saddle to be with other diseases such as pituitary adenoma, optic nerve glioma, meningioma saddle area carotid artery aneurysms and tumors such as differentiated from embryonic tissue, because
Drug treatment for these lesions can also damage the saddle and the optic chiasm, optic nerve and optic tract and cause similar symptoms; to pituitary dysfunction as the main performance needs and other diseases caused by pituitary dysfunction differentiated. 1. Craniopharyngioma pituitary and pituitary adenoma should be differentiated from the first, because both endocrine and visual disturbances may occur, clinical manifestations similar to, and sometimes substantial intrasellar craniopharyngioma is also difficult to type on CT and Pituitary differentiated adenocarcinoma. Sellar pituitary tumors account for the first, more common in adults aged 20 to 50, to vision, vision disorders as the main performance, mostly for double-temporal hemianopsia, eyes almost all primary optic nerve atrophy. Mainly anterior pituitary dysfunction, but no growth retardation, generally do not produce increased intracranial pressure. Sella mostly spherical expansion without calcification. CT scan showed isodense or slightly higher density mass, enhanced scan shows homogeneous enhancement. 2. Tuberculum sellae meningiomas and pituitary adenoma and craniopharyngioma addition, sellar tumor that is common tuberculum sellae meningiomas, ranking third. 25 to 50 years as the high age. Early in general no endocrine disorder, may have visual impairment and headache. Advanced Vision disorders and fundus may appear of primary optic nerve atrophy. Sella obvious changes, some visible damage to the saddle or nodular hyperplasia, calcification rare. CT scan showed a slightly higher or equal density mass showed homogeneous enhancement in the tumor. 3. Sellar region tumors germ cell tumor of the pineal gland is ectopic, accounting for fourth place, 70% of patients age 7 to 20 years old. Multiple endocrine disorders, but to highlight the symptoms of diabetes insipidus may be associated with precocious puberty may also have visual acuity, visual field changes. Sella normal. 4. Optic chiasm glioma occurred in 7 to 20 years old, a rare endocrine symptoms, mostly visual changes mainly showed prominent monocular, visual disturbances, headache. Expansion of the optic nerve Condo, no calcification. CT scan for the low-density mass, usually no or mild enhancement. 5. Sellar epidermoid cyst is rare, the vast majority age of 23 to 37 years old, with vision, vision disorders as the main performance, the general non-endocrine disorders, increased intracranial pressure symptoms are rare. Sella normal, without calcification, CT scan showed low density lesions in the saddle area, CT values are mostly negative, not strengthened. 6. Chordomas occurred in the 35-year-old to a number of brain injury as the main performance, often calcified, sella Department and the Department of significant bone destruction slopes. CT showed a slightly higher density of irregular lumps, including calcification, enhancement does not occur most, a few may have even mild enhancement. 7. Sellar aneurysm rare, more common in middle-aged, with sudden onset, headache, oculomotor nerve palsy is characterized by normal sella no change in cerebral angiography can be confirmed. Intraoperative biopsy was blood, tumor did not collapse. 8. The third ventricle glioma occurred in front of adults, usually without endocrine symptoms, increased intracranial pressure as the main performance. Sella generally no change in the tumor rarely calcification, CT scan can be identified. 9. Optic chiasm arachnoiditis more common in adults, with visual acuity, visual field changes as the main performance, visual field changes generally erratic, irregular changes, reduced vision, the general non-endocrine disorders and increased intracranial pressure. Sella normal, CT scan without sellar lesions. 10. Primary empty sella is rare, middle-aged disease, the vision, vision disorders, headache as the main performance, sometimes endocrine symptoms are sometimes difficult to clinically differentiated from craniopharyngiomas, CT scan revealed within the saddle cavity. 11. Sellar arachnoid cyst in a rare, more common in children, also found in adults, the main symptoms of intracranial hypertension caused by hydrocephalus, may have visual acuity, visual field changes, a small number of patients with endocrine symptoms, expand or double saddle sella bottom, CT scan see the cerebrospinal fluid density, circular low-density areas. Craniopharyngioma and the identification of various diseases, mainly rely on the following 2 points: In addition to the above-mentioned various diseases caused by similar performance with craniopharyngioma, there are other performance does not meet the craniopharyngioma; the management of various disease and craniopharyngioma performance in imaging tumors are different. In general, through the CT and MRI, clinical manifestations, most cases can be diagnosed. In rare cases, surgery may need to rely on biopsy specimens before they can confirm the diagnosis. Treatment Method 1. Resection: viable total or subtotal, but the tumor and carotid artery, optic nerve and so closely linked to the surrounding tissue and a large tumor invasion of surrounding tissue, the effect is often not satisfactory, the recurrence rate, and easy to produce diabetes insipidus caused by hypothalamic damage, temperature disorders, aseptic meningitis. Symptoms improved after surgery is not ideal. 2. Head Gamma Knife: Gamma Knife treatment of craniopharyngiomas current technology is mature, because the accuracy of gamma knife treatment, so little can hurt normal tissue surrounding the tumor. For cystic tumor, gamma knife treatment in the cystic fluid after the puncture. 3. Chinese medicine treatment: anti-tumor brain series is compatible applications, applicable to non-surgical or surgical resection, recurrence, X-knife, γ-knife, radiotherapy and chemotherapy in patients after 3 months treatment can eliminate symptoms, so that reduction or disappearance of tumor, surgical treatment to eliminate residual tumor, preventing recurrence of clinical curative effect for many years. Option 1. Craniopharyngioma surgery is the preferred surgical treatment. The purpose of surgical removal of the tumor by the tumor on the optic nerve to lift the cross and other nerve tissue of oppression, relieve increased intracranial pressure, the hypothalamus - pituitary dysfunction is more difficult to recover. For solid tumors, tumor resectability; for cystic tumor, surgery can be put to the cyst fluid, thus easing the symptoms of tumor suppression. Craniopharyngioma is benign because, in addition to part and the optic chiasm, tuber cinereum, pituitary stalk, hypothalamus, and so somewhere in the end of the third ventricle adhesion, most of the organizational structure and glial reaction around the borders or boundaries arachnoid Therefore, in principle, should strive to achieve complete resection, especially for pediatric patients to prevent recurrence. Especially small intrasellar craniopharyngioma tumors are typically taken by the butterfly-type procedure, and large tumors to be taken by transcranial operative. In general, successful surgery can relieve pressure on the optic chiasm due to vision, vision changes and headaches caused by high intracranial pressure and other symptoms, but also the pituitary function was restored. However, many saddle-type craniopharyngioma with the surrounding brain tissue (especially the hypothalamus) are closely linked, increasing the difficulty of surgery, these patients do not insist on complete resection, can take partial resection, partial resection of the disadvantage is that patients relapse rate is high. According to tumor location, size, shape, degree of calcification, cyst part of the location, and the relationship with the surrounding tissue and accessible cerebrospinal fluid pathway and other factors, need to choose a different surgical approach or methods, and each has its advantages and disadvantages. Approach to the amount of exposure of the end of the main structure of the optic nerve, chiasm, internal carotid artery, anterior cerebral artery, the pituitary stalk and so on. For post-type optic chiasm, saddle grew larger tumors within the saddle, or saddle on the growth of the ventricles prechiasmatic appearance on the tumor. This approach can be further divided into several different surgical procedures: such as through the optic chiasm under the operative, or if the optic chiasm front, removal of tuberculum sellae and sphenoid bone plate to reach the optic nerve or open between the end plate surgical technique type, and from the carotid artery between the optic nerve or optic tract to reach the tumor were selected. Pterional approach similar to the end with the temporal, but the path is the shortest direct route to the saddle area. Can be exposed carotid artery, anterior cerebral artery, optic nerve and optic tract, optic chiasm, and under the rear of the pituitary stalk, the end of the third ventricle, cerebral peduncle between the nest and on the slopes, etc., apply to the saddle on the side of the growth within the saddle or under the saddle on the optic chiasm and optic chiasm between the rear foot pool ventricle shape tumor. The approach most widely used is the main method of surgical removal of craniopharyngioma. End-plate approach under the amount by unilateral approach, pterional and interhemispheric approaches double the amount can be reached after the optic chiasm and open end plate, extended exposure to the third ventricular tumors. Thus, this approach applies to chiasma lead type, the saddle after optic chiasm indoor appearance of brain tumor growth. The corpus callosum or the lateral approach if the tumor grew into the third ventricle, can approach through the corpus callosum (without significant lateral expansion) or the left ventricle into the Road (between room hydrocephalus caused by pore blocking). There are several ways to enter the third ventricle and exposed to cancer: ① separation of unilateral fornix; ② separation chamber between the hole next to a vein; ③ to enter by the choroid plexus; ④ isolated brain vein. Transsphenoidal fully in the saddle or the saddle in the saddle within the mild growth or the growth of the sphenoid sinus tumor, transsphenoidal approach can be used. Other approaches and methods for the total removal of the tumor, and sometimes surgery to be carried out in phases, such as the saddle on the first part of transcranial tumor resection, and then elective transsphenoidal resection of intrasellar part of the tumor, or for the removal of giant tumors of two or more taken into the road combined approach. In general, the surgical approach selected, the axis or external approach through the central axis than the unilateral approach or bilateral approach is more desirable approach. To which part of the tumor should be removed as far as possible the functional organization. Surgery should be used microscope, note the level of distinction and protection of arachnoid and interface, which will help to safely remove the tumor. Usually after the first exposure of the tumor cyst fluid extraction of tumor biopsy, surgical separation of the tumor to create the space capsule and the arachnoid and to separate the re-resection of the tumor capsule, to be followed after the tumor shrink the tumor coagulation and separation of supply vessels. Surgery to protect the supply of the optic chiasm and optic tract in the median eminence fit around the blood vessels, the tumor grew to the rear and upward part of the third ventricle of the tumor is almost no major artery, adhesion is not tight, but in isolated basilar artery and posterior cerebral artery when the tumor is very careful, because the adhesions are usually more closely here. Tumors are often located in the bottom of calcification, particularly in the optic chiasm and optic nerve often below the line to be removed after the first crush. Sometimes this part of the tumor calcification and nerves, blood vessels, such as pituitary stalk in close adhesion, removal of difficulties. Long to the bottom of the third ventricle tumor often makes the local formation of glial reaction layer, separation wall should be carried out within this layer, if the third ventricle has a layer of thin plastic layer which was (with the thicker part of the nucleus has been over the top), the layer can be opened. Within the surgical field as seen in block tumor capsule should be removed, but the adhesion of those tight, not too fussy cut, so as not to damage the hypothalamus and other important nerves and blood vessels. Required surgery to get through cerebrospinal fluid circulation, it is difficult shunting should be smooth. Surgery related factors can be totally removed with the following factors: ① age, children around the patient's tumor and fewer adhesions, easily removed, usually younger, the more easily be totally removed, complications are less. Adult Craniopharyngioma more with the surrounding tissue (pituitary, hypothalamus, carotid artery, skull base arterial ring, the optic nerve and optic tract cross, etc.) adhesion is very tight, the Ministry of tumor nodules buried in ash, which often makes total resection surgery After many complications and high mortality. ② initial surgery and recurrence of surgery, compared with relapsed patients the first operation second operation easier, more chance of tumor resection, the mortality rate is relatively low. ③ clinically significant pituitary, hypothalamic dysfunction, only suitable for resection. ④ tumor location, the type and saddle type easier for prechiasmatic resection, after the type of optic chiasm and ventricular-type nodules should be under the wall and gray, hypothalamus, etc. The adhesive chosen for subtotal or partial resection. Although some cases for surgical resection, even after normal CT scan review may still have more residual tumor cells and recurrence. 15% to 30% of the patients had preoperative hydrocephalus, if only the resulting symptoms should first shunt. If patients with disturbance of consciousness, severe symptoms of the hypothalamus, can not tolerate craniotomy, stereotactic cyst puncture can first take away the cyst fluid, to reduce the partial pressure of the tumor. Preoperative and postoperative care of psychological nursing care a multiple of craniopharyngioma in children and young people, their mental capacity is poor, once diagnosed, the psychological burden is heavy, easy to fear, pessimistic psychology. In addition, open surgery has some risk, patients often feel uneasy, fear and restlessness, affecting rest and sleep, and even refused surgery. To this end the patient's nurse patiently answered all questions, the lifting of the patient's ideological concerns, and describes successful case, and establish the confidence of patients overcome the disease. 2 visual perspective for the assessment of craniopharyngioma direct pressure optic nerve, chiasm and optic tract, 70 to 80% of the patients had vision, vision disorders. Nurses can be rough preliminary understanding of the patient's visual acuity test, visual field, the specific method: the patient level as the front, with a finger up, down, left, and right directions equidistant activity in patients with visual field examination. Different distances in front of the patient (such as 1 m, 2 m, 3 m, etc.) index for assessment of vision by hand, records were compared with the postoperative visual acuity.
Add to Favorites relevant content summary of problems have been solved question :2008 -09-19 18:49:30 731 001 members novice Add as Friend initial diagnosis of hypothalamic pituitary stalk tumor, craniopharyngioma possibility of large tumor about 3 cm, combined with mild hydrocephalus, brainstem compression edema, usually eat . Sex: Male Age: 15
Tentative diagnosis of hypothalamic pituitary stalk tumor, craniopharyngioma possibility of large, tumor about 3
cm, combined with mild hydrocephalus, brainstem compression edema, usually could not eat, people very thin, like ice water , 05 have been found to have diabetes insipidus, a coma since Sept. 15, 18, woke up the morning,
I would like to ask, hospitals can not treat the disease, can complement with traditional Chinese medicine to treat the problem: Can Chinese medicine hospital treatment of the disease complaints of professional response to this issue of professional portrait of a medical practitioner or practitioners to answer back this time to answer complaint :2008 -09-19 18:24:32
This is considered the best surgical treatment. I'm afraid, or simply not work with traditional Chinese medicine. This is considered the best surgical treatment. I'm afraid, or simply not work with traditional Chinese medicine. From Granville County, Xingtai City Hospital personnel Schools
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