Prophylaxis and treatment of postoperative complications of large craniopharyngioma resection

Objective To analyze the postoperative complications of large craniopharyngioma (diameter above 40mm)resection and effective prophylaxis and treatment of the tumor.Methods Among the 40 patients with large craniopharyngiomas,craniotomy was performed via the pterional approach in 20 patients,the supraorbital keyhole approach through the superciliary arch in 11 patients, the trans-frontal-callosal-interforniceal approach in 6 patients and the anterior interhemispheric approach through the lamina terminalis in 3 patients;tumors were dissected via the parachiasmal opticocarotid and carotidotentorial spaces in the sellar region and by opening the lamina terminals.Much attention was given to the preservation of perforating arteries from the internal carotid artery,anterior and posterior communicating arteries and anterior choroidal artery to the hypothalamus.Injuries to the hypothalamus and hypophysial stalk should also be avoided.The solid portions of tumors were removed by pieces after tumor cyst fluid had been aspirated.Results Total resection was achieved in 36 of the 40 patients; subtotal resection in 1 with calcified residual capsule wall in the lateral ventricle,which remained to be unchanged over a long period of time;adjuvant radiotherapy was conducted in patients with residual tumors,1 in the sellar region and 2 in the sideward sellar region.During the earlier period after resection, 26 patients developed diabetes insipidus,33 developed electrolyte(sodium,chlorine,kalium and calcium etc)disturbances of various degrees,2 developed hyperpyrexia and poor recovery of consciousness and 6 developed aggravation of visual acuity decline,which were all alleviated after active treatment.A total of 36 patients participated in the normal activities at different time points,2 still needed living assistance,1 died from the complication of diabetes insipidus and 1 died from hemorrhage in the operative site. Conclusion Good preoperative preparation,different surgical approaches applied according to the localization and size of tumors,assurance of favorable illumination and a view of the operating field, sharp intraoperative anatomy as much as possible under direct view to preserve the hypophysial stalk and hypothalamus as well as its small perforating arteries and immediate postoperative monitoring the changes of water-electrolyte shall contribute a lot to the prophylaxis and treatment of postoperative complications of large craniopharyngioma resection.