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Craniopharyngioma (craniopharyngioma) originated in the pituitary during embryogenesis remnants of flat epithelial cells is a common congenital intracranial benign tumors are located above the sella, a few differences in the name of intrasellar craniopharyngioma many with the initial location and growth-related, such as the saddle on the cyst, cranial cheek pouch tumors, pituitary tumor ameloblastoma tube, epithelial cysts, tumors and other enamel.
Onset craniopharyngioma in children and adolescents more than its main clinical features are the hypothalamus - pituitary dysfunction increased intracranial pressure, visual acuity and field of vision disorders and neurological and psychological symptoms of diabetes insipidus. CT scan can confirm the diagnosis. Treatment is mainly surgical excision of tumor. Etiology:
The disease is congenital, slow growth during normal embryonic development of oral Rathke pouch connected to the original pipe that craniopharyngioma slender tube, this tube will gradually disappear with the embryonic development of the anterior wall of Rathke pouch remnants of the former Ministry of degradation of leaf nodes 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 some can invade the third ventricle posterior fossa.
Most of the buccal tube Craniopharyngioma originated in the cranial infundibulum clos


e 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 network cells, the tumor was located in the saddle, which formed the so-called "saddle the type" part of craniopharyngioma craniopharyngioma in the suprasellar and intrasellar have, the pathogenesis of the tumor was dumbbell-shaped:
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 was first observed in the normal pituitary gland nodules are remnants of the Ministry of squamous cells that originated in the residual craniopharyngioma epithelial cells in the embryo The first 2 weeks of oral top up the original formation processes of a deep blind bag, called the bags with the further development of Rathke Rathke bags were beneath the narrow and thin tube, that is called the cranial pharyngeal tube or pipe under normal circumstances, the pituitary embryos 7 to 8 weeks craniopharyngioma tube that gradually disappeared during the development of epithelial cells often left the nest becomes craniopharyngioma tissue of origin.
(2) squamous metaplasia theory: Luse and Kernohan 1955, 1364 cases were observed in the pituitary gland autopsy found that only 24% of squamous cell nests, which appeared the growth rate increased with age, 20 years of age scales like the low rate of epithelial cell nests appeared squamous cell so they think the nest is a product of the pituitary cell metaplasia, rather than embryonic residues. Furthermore, it was observed that the pituitary gland cells and squamous cells mixed, and to see between the two over-the findings support metaplasia theory
2. Pathologic changes generally larger size of craniopharyngioma, the tumor often has spherical shape, irregular, or nodular growth and expansion, no envelope, clearly limits the scope of the size difference was mostly or partly cystic-like multi-room cystic, and the minority with only a few small cysts substantial tumor cyst fluid can be gray red 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 on top of wall thickness ranging from a smooth surface, such as translucent thin may, there are many gray or brown and may calcification or ossification of calcified plaque was eggshell-like, cystic degeneration of the content of the epithelial cells of liquefied Mai debris (keratin-like material), cyst fluid was yellow oil-like liquid containing flash or floating cholesterol crystals, generally 10 ~ 30ml, were up more than 100ml or more. After the tumor is usually located below the real Ministry of nodular calcification containing dense hard times often associated 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 sometimes broke into the hypothalamus was papillary cancer surgery might cause a distraction injury of hypothalamus in the saddle in many solid tumors or cystic third ventricle volumes than those for small
Tumor shape can be divided into enamel-and squamous papillary type two. Common type of enamel occurs mainly in children. This type of columnar epithelial cells in the outermost layer of the gradual shift to the center of the outer acts of the inner palisade cells were loosely arranged stellate cells. Degeneration of tumor tissue are often keratosis capsule exfoliated cells and small cysts formed after the absorption of calcium in the calcification as many scattered the salient features of craniopharyngioma craniopharyngioma almost all calcifications can be seen in the microscope, the majority of cases in radiographic calcification can be found in 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 well-differentiated put forth by the flat epithelial cells, of which every rich fibrovascular stromal cell envelope of natural crack or split and the formation of the lesion prominent pseudopapillary general non-keratinized type of enamel beads, calcification, inflammatory response and cholesterol deposits of this type are mostly solid tumors. Craniopharyngioma occasional reports rapid growth, was invasive recurrence Mai, 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 there that have a direct artery from the carotid artery blood supply, but after the traffic management craniopharyngioma tumors do not accept from the posterior cerebral artery (or basilar artery) and blood vessels unless the blood supply of tumors close to the bottom of the third ventricle. Intrasellar tumor blood supply from the cavernous internal carotid artery through a small artery.
Around the growth of tumors to the pituitary gland may compress the optic nerve crossing, the third ventricle or hypothalamus block the bottom side or both sides of the rooms between the hole and causing obstructive hydrocephalus. Intrasellar tumor of mostly substantive, early limited to smaller intrasellar pituitary directly after the upward pressure can affect the optic chiasm and the growth of the third ventricle. Clinical manifestations:
Craniopharyngioma can be seen at any age but most common from 6 to 14 years old most of the growth of craniopharyngioma is intermittent so the whole tumor is slow, slow development of their symptoms; a small number of fast-growing craniopharyngioma, which progress of the disease is also faster. The clinical manifestations include the following: the tumor mass effect and block the room between the holes caused by high intracranial pressure performance; tumor compression optic chiasm, optic nerve caused by visual impairment; pituitary tumor compression caused by the hypothalamus - pituitary dysfunction; brain tumor invasion and other causes of neurological, psychiatric symptoms, mainly in the following 5 aspects:
1. Craniopharyngioma increased intracranial pressure performance of larger intracranial space-occupying lesions as a health search, it can be directly caused by mass effect, intracranial hypertension. Oppression of the third ventricle craniopharyngioma also, blocking holes leaving room between the intracranial pressure, which may be their main reason for high intracranial pressure caused by increased intracranial pressure symptoms more common in children, the most common were headache light can be heavy, 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 Mai. After more than a headache in the orbital for the diffuse radiation to the neck and back.
Suture closure in children are not separated prior to the bone sewing head circumference increased, percussion sound was broken pot, scalp vein engorgement and so on. Cause of intracranial hypertension were mostly large cysts, tumor compression chamber between the hole blocking the third ventricle obstructive hydrocephalus can also cause the pressure in the cyst can sometimes make their own change automatically relieve symptoms of intracranial hypertension occasional tumor cyst rupture , overflow into subarachnoid cyst fluid, can cause chemical meningitis and arachnoiditis manifested as sudden severe headache, vomiting, meningeal irritation with symptoms such as neck and positive signs against Kening cerebrospinal fluid 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 in the 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, defect for the quadrant hemianopia, dark spots and other tumor oppression of the optic chiasm can cause visual field defects common to the two temporal hemianopsia see, for example under dual-temporal quadrant of the 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, optic nerve atrophy may be of secondary motor neurons may be affected eye double vision and other symptoms saddle type of tumor in the optic chiasm compression from bottom to top generate the same visual field defects and pituitary and optic atrophy, vision loss can sometimes hemorrhagic infarction due to blood circulation at the optic chiasm disorders Erzhi sudden blindness. Had primary optic atrophy optic disc edema rarely happen again when the tumor growth to one side can produce Foster-Kennedy syndrome. Early visual field defects in children and more attention until the vision is not a serious obstacle 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 Niaobeng Zheng incidence 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 tumors door pulse 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 inhibitory hypothalamic damage and can be nerve Mai pituitary function caused by hyperthyroidism, a common expression of sexual precocity, acromegaly, Cushing deeper skin pigmentation disorder; some patients with obesity, lethargy, mental disorders, vasomotor dysfunction and other symptoms.
(1) obesity sexual reproductive incompetence syndrome: nodular hypothalamus Ministry of Health management of the search 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 women in menopause lost libido, lactation disorders disappearance of secondary sexual characteristics
(2) body temperature regulation disorders: clinical and more damage to the rear of the hypothalamus showed a lower body temperature (35 ~ 36 ) the phenomenon of a small number of patients may have chills; anterior hypothalamus can cause the affected central high fever (39 ~ 40 )
(3) diabetes insipidus: a day showed an increase of up to several thousand milliliters of urine and even more so drink lots of water 10000ml Mai, children's beds at night easily drowned. Diabetes insipidus due to tumor injury Nucleation supraoptic paraventricular hypothalamus - pituitary neurohypophysis induced beam or antidiuretic hormone (ADH) secretion decreased or lack of, but polyuria and normal secretion of ACTH at the same time, such as damage to the anterior pituitary, decrease in ACTH secretion will not have diabetes insipidus. Sometimes due to hypothalamic thirst center also destroyed, you can have decreased thirst syndrome with diabetes insipidus, diabetes insipidus although the plasma of patients with high permeability state, but no thirst. Forbidden to drink urine osmolality at the time does not rise or rise slightly, hypovolemia, hypernatremia syndrome. Tachycardia patients can produce headaches, irritability, delirium and even coma fuzzy mind, and sometimes can produce episodes of hypotension.
(4) lethargy: rope light are seen in advanced cases can still wake up in weight from sleeping all day
(5) psychiatric symptoms: forgetfulness, such as attention focused fiction and other non-Mai, and hypothalamus - hypothalamus limbic system or frontal lobe damage on , adults were more common.
(6), bulimia or poor feeding disorder: ventromedial hypothalamic nucleus of satiety center damage may have bulimia (obese patients), ventral lateral nucleus of the preferable center may have anorexia or poor feeding damage symptoms (weight loss patients with clinical Jiao rare to.4. Pituitary dysfunction, pituitary dysfunction, symptoms of pituitary hyperfunction more common especially in LH / FSH and GH were more common lack of pediatric patients reported to have growth delay of about 50% of the health of the search, about 10% of the apparent short stature in children sex hypoplasia. The performance of adult patients with GH deficiency is not outstanding, but sexual dysfunction in 30%. TSH deficiency causes secondary hypothyroidism met / 4 of the patients, ACTH deficiency causes secondary adrenal insufficiency is not uncommon
Children's lack of pituitary function of patients as early manifestation of the body physical growth retardation short, thin, easy fatigue weary activity, the skin smooth and pale yellow complexion, and teeth and bones wrinkles looks old bones do not stop the development of joint or delay Mai joint organ was infantile, no secondary sexual characteristics also showed a small number of classes were non-testis may have cold symptoms, mild mucous edema, low blood pressure was Simmond cachexia and even adult women who have menstrual disorders or menopause, infertility and premature aging phenomenon. Loss of libido male hair loss occurs, low blood pressure, low metabolism (up to 35%), etc.
5. Adjacent to symptoms such as the tumor can grow to both sides to the surrounding growth, invasion of the temporal lobe can cause temporal lobe epilepsy and brain tumor invasion extended down to the foot, can produce spastic paralysis and even brain tonic state of some patients to be the performance of mental disorders for the memory loss and even loss of consciousness severe apathy or dementia, such as fuzzy growth to the parasellar cavernous sinus syndrome may have caused , cranial nerve disorders; to the sphenoid sinus growth may cause nose bleeding, cerebrospinal fluid rhinorrhea, etc.; to the growth of the anterior cranial fossa may produce psychiatric symptoms, such as memory loss and poor toilet Mai orientation 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 olfactory magic magic taste and other psychiatric symptoms; small number of patients can be back the growth of tumors arising from brain stem symptoms, and even long into the posterior fossa cerebellar symptoms and a small number of patients caused by olfactory nerve and facial nerve involvement can also be expressed as the sense of smell loss and facial paralysis
All of the above symptoms in children and young adult patients with slightly different patient frequency of the former common first symptom of intracranial hypertension, which is common to all patients with optic nerve compression symptoms of endocrine changes are possible but the adults found that early concurrent Disease:
Craniopharyngioma longer course of slow growth, the main damage to the hypothalamus and surrounding structures caused by endocrine disorders, vision, visual field damage and increased intracranial pressure after treatment with surgery complications are common '
1. Central high fever in patients with persistent high fever, coma prognosis was poor, often symptomatic treatment may be due to: craniopharyngioma resection of hypothalamic function is impaired thermoregulatory dysfunction caused by high fever Erzhi; cystic tumor cyst fluid within the meninges and hypothalamic stimulation produces aseptic meningitis; surgery fever caused by bloody CSF stimulation
After close observation of hot type and duration, the difference central high fever and lung, urinary tract infection due to high fever. Used with caution in patients with hibernating fever drugs given after surgery to prevent disturbance of consciousness caused by head ice, ice cap or the body of ice blanket, continuous rectal temperature monitoring of the rapid control of body temperature at 38.5 below. Surgery due to hypothalamic damage cupping network.
2. Cupping network is the major disturbance of consciousness hypothalamus increased intracranial pressure caused by damaged or increased intracranial pressure causes: postoperative hydrocephalus caused by blood clots blocking the aqueduct; surgery to stop bleeding is not completely caused by subdural hematoma or subdural hematoma; electrolyte imbalance caused by surgical stimulation or secondary brain edema. Nurses, patients should be closely observed changes in consciousness and pupil, in particular, to observe within 72h after surgery in patients with or without nausea, vomiting and stiff neck wound and other symptoms of tension increase and maintain drainage tube drainage of fluid flow to observe the color and volume. To have impaired consciousness, with Glasgow coma score Evaluation of level of consciousness. Timely detection, prompt and correct treatment.
3. Insipidus in the tumor resection or radical subtotal removal of the patient almost inevitably occurs Huoguan network complications to surgery when the damage caused by pituitary stalk after pituitary stalk damage, ADH release put forth a three-phase The Mai ADH after the initial release of the pituitary stalk to reduce damage caused by diabetes insipidus; axon terminals of neurohypophysis after the release of surplus physiological variability of the amount of ADH release process is common in pituitary stalk injury 48 ~ 96h, if the time given to patients with long-term (oil) anti-diuretic agent (usually a short-acting vasopressin), may lead to the release of endogenous ADH caused by reduced renal function; when the degeneration of nerve endings release of recurrence after hormone depletion diabetes insipidus. General diabetes insipidus last several days to 2 weeks can restore, but also a few permanent diabetes insipidus. For as follows:
(1) The key observation in patients with polydipsia and polyuria, polydipsia, such as performance and urine output, urine specific gravity, recording 24 h liquid intake and output of fluids under the urine out of <5000 ml / d is no need for drugs. Well the water conscious person; trance who, after 2 ~ 3h to give indwelling stomach tube, add water and nutrients urine ou 5000 ml / d, urine specific gravity <1.005 by subcutaneous injection of vasopressin 5U 1 / dhttp, or diabetes insipidus stop 0.3ml1 times / d intramuscularly. Diabetes insipidus light often give hydrochlorothiazide (hydrochlorothiazide in urine plug), carbamazepine oral treatment, severe cases can be applied to short-acting vasopressin, during which pay attention to controlling into the liquid to prevent water intoxication (at which time patients may have edema, tic embolism occurs)
(2) Regular measurement of serum sodium, potassium, chloride, carbon dioxide combining rate, and pH, and blood urea nitrogen and so on. 3 to 5 days after every 12 hours, 1 test electrolyte loss can be normal if the electrolyte added; if the cause sodium retention (increased serum sodium and osmotic pressure increased), should limit sodium intake; sodium chloride supplement in patients with low chlorine sodium to prevent cerebral edema; given orally to prevent hypokalemia 1000ml urine potassium supplement potassium chloride 1g. In addition, to maintain potassium, calcium levels in normal glucose Mai
4. Circulatory failure patients before surgery significantly impaired pituitary function, surgery is easy to produce the phenomenon of acute adrenal failure, the patient showed a state of shock
Should be added before the treatment is surgery after a failure, the phenomenon of hormone were given large doses of adrenal cortex hormones. This not only reduces the crisis response may also reduce the hypothalamus and brain edema, prevention of central high fever is also an active role. However, in order to reduce gastrointestinal bleeding and other complications, such as infection, should be gradually reduced after 4 days normal dosage after 2 weeks with a maintenance dose to gradually stop (other than pituitary dysfunction was).
5. Epilepsy due to surgical trauma and damage to the hypothalamus traction, after anesthesia, awake epilepsy. Preoperative oral administration of phenytoin sodium 0.1g, 3 times / d; of surgery or intramuscular injection of 10mg of phenobarbital 0.1g stability and the prevention of postoperative monitoring in patients with or without an argument or observation EEG twitch, eyelid tremors, twitching fingers, etc. abnormal signs before the seizure medication that is timely and repeated seizures medication while maintaining the airway, give oxygen inhalation, to prevent cerebral hypoxia
6. Gastrointestinal bleeding due to damage to the hypothalamus after the gastric ulcer or erosion caused by reflex induced upper gastrointestinal bleeding and a large number of patients after application of corticosteroids may have melena or hematemesis and other acute gastric perforation.
Postoperative cimetidine, close observation of blood pressure, pulse and stool color indwelling gastric tube were observed to digest the food situation in the stomach and gastric juice color. Sudden hematemesis melena fast pulse rate, gastric lavage with saline ice through blood transfusion thrombin injecti000IU 1 / 4h, and the application of omeprazole, cimetidine, etc. to give blood transfusion, application of hemostatic agents H2 receptor blockers etc., and fasting, gastrointestinal decompression, disable hormones, if necessary, timely surgery to control bleeding.
7. Aseptic meningitis, cystic neoplasms contents meningeal stimulation during surgery due to overflow. For this reason, surgery should be as much as possible to remove the tumor, repeated washing with saline for multiple cysts after lumbar puncture cerebrospinal fluid discharge, hormone applications also help alleviate symptoms such as fever
8. Visually impaired patients in the injury of vascular supply of the visual pathway and visual impairment can be caused by pre-shaped optic chiasm in particular a higher incidence of cancer should be noted
9. Hypopituitarism especially preoperative hypopituitarism and generally more difficult to recover. Short stature in children with growth retardation, incomplete sexual development such as health searches. Be thyroid hormone and other drugs treatment and strengthening exercises, is expected to have some degree of recovery, but not sure.
10. Other radionuclides craniopharyngioma tumor capsule complications after irradiation treatment of various reports can be summarized as: Cross-optic tract optic nerve damage, hypothalamus, brain radiation necrosis, vascular thrombosis, and radiation induced tumors and a handful of diagnosis of tumor recurrence or death:
Patients of any age with high intracranial pressure, such as neurological eye symptoms and the hypothalamus - pituitary dysfunction should consider the possibility of craniopharyngioma predilection sites based on clinical manifestations and diagnosis of craniopharyngioma is not difficult to assist young children who appear development of small endocrine dysfunction, such as polydipsia and polyuria, obesity, genital hypoplasia, etc., should first consider the patient; if the saddle or the saddle is more helpful in diagnosis of calcified plaque Mai. If adult sexual dysfunction or headaches, visual field of vision disorders, the disease should also be considered
A small number of atypical clinical manifestations of mild clinical symptoms were not easily diagnosed, the key is to increase the vigilance of this disease Mai Mai CT and MRI through the laboratory of great significance in the diagnosis of suspected cases, this examination should be done promptly to avoid delay in diagnosis differential Diagnosis:
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, meningioma optic nerve glioma carotid artery saddle tumor and embryo tissue tumors such as phase identification, because these lesions can also damage the saddle and the optic chiasm, optic nerve and optic tract and cause similar symptoms; to pituitary dysfunction is mainly caused by the needs of pituitary dysfunction and other diseases that health search phase identification.
1. Craniopharyngioma pituitary and pituitary adenoma should be differentiated from the first, because both endocrine and visual disturbances may occur, clinical manifestations, sometimes substantially similar to the type of craniopharyngioma in CT on the saddle is difficult with the pituitary gland differentiated tumors. Sellar pituitary tumors account for the first, more common in adults aged 20 to 50, to vision as the main obstacle to the performance of multi-dual-temporal hemianopsia eyes almost all primary optic nerve atrophy. Mainly anterior pituitary dysfunction, growth retardation without increased intracranial pressure is generally not produced. Mostly spherical expansion of sellar CT scan showed no calcification and other higher density, mass density or 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 in the 25 to 50 years for the high incidence of early age, may have general non-endocrine disorders and visual impairment headache, vision impairment and can occur late primary retinal optic disc atrophy. Sella have put forth visible change is not obvious saddle nodular hyperplasia or damage, a rare CT scan showed calcification, or other higher 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 in multiple endocrine disorders cupping network, but to highlight the symptoms of diabetes insipidus may be associated with sexual Kentucky also has vision, visual field changes in normal sella
4. Optic chiasm glioma occurred in 7 to 20-year-old rare endocrine symptoms, mostly visual changes mainly showed prominent monocular, visual disturbances, headache. Expansion of the optic nerve Condo without 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, the visual field of vision as the main obstacle to the performance of general non-endocrine disorder symptoms of increased intracranial pressure normal sella rare, no calcification, CT scan showed low density lesions in sellar region more than the value of CT is negative, no enhancement
6. Chordomas occurred in the 35-year-old to a number of brain injury as the main performance, often calcified sella Department of the Ministry and the slope significantly CT showed irregular destruction of bone mass density, which is slightly higher calcification, most do not a few may have even occurred to strengthen mild enhancement.
7. Sellar aneurysm rare, more common in middle-aged to sudden onset of oculomotor palsy is characterized by headache, sella generally no change in cerebral angiography can be diagnosed as a blood puncture surgery Mai cupping net mass does not Taxian
8. The third ventricle glioma occurred in front of adults, generally no endocrine symptoms of increased intracranial pressure as the main performance. Sella tumors generally did not change very little calcification, CT scan can identify 9. Chiasm arachnoiditis more common in adults with visual acuity, visual field changes as the main performance of visual field changes were irregular erratic changes in the general field of vision narrow the general non-endocrine disorders Mai normal sella and increased intracranial pressure, CT scan lesions without saddle
10. Primary empty sella is rare, middle-aged disease, the vision, vision disorders, headache and sometimes occur as the main manifestation of endocrine symptoms are sometimes difficult to clinically differentiated from craniopharyngiomas, CT scan showed the cavity within the saddle .
11. Sellar arachnoid cyst in a rare to common in children can also be found in adults, the main symptoms of intracranial hypertension caused by hydrocephalus, visual field changes may have vision, a small number of patients with endocrine symptoms of sellar expansion of cable CT scan or two-sellar See 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. CT and MRI examination in general through the combination of clinical manifestations, most cases can be diagnosed. In rare cases, surgery may need to rely on biopsy specimens can be diagnosed before1. Skull X-ray 80% to 90% of patients had skull X-ray abnormalities of children with abnormal skull plain films accounted for 94% of adults accounted for 60%. The main difference usually presents the following three aspects.
(1) tumor calcification: calcified craniopharyngioma a variety of forms, as the salient features of craniopharyngioma on the type and saddle-saddle type of tumor are calcifications within, while the other saddle very rare lesion calcification (calcification rate of more than below 1%). Calcification in children than in adults, the incidence of common childhood craniopharyngioma calcification 70% ~ 85%, 2 years of age accounted for 20% of children over 2 years of age accounted for 80 calcified? 50% of those over the age of about 35% of adult children Saddle height should be considered within the calcified craniopharyngioma. Calcification can be very flexible, can also be distributed together was sometimes thin line-shaped curve. Calcification often appear in the middle zone, and occasionally larger lesions may be limited to the surrounding part of the calcification. 60% ~ 81% of the patients experienced tumor calcified plaque, was single or bulk form can also be blended into the egg-shaped
(2) sella change: children with TSH and GH because of the lack of bone X-ray can show bone age decreased. Most craniopharyngiomas can be down at the top of the sella turcica sellar pressure on it in the skull plain film changes can be found in a flat sella clinoid damaged. Craniopharyngioma in the saddle a few, the Mai visible on plain film in the skull to expand the sella turcica. Virtually any type of change can be seen in sellar craniopharyngioma, may be typical of the saddle on the saddle of tumor changes can also be changed within the tumor. 35% of the patients was basin-shaped, or sellar enlargement or destruction of spherical and saddle back clinoid can be sharpened, decalcified, disappeared. Sella change significantly lesions often have great tips, and vice versa m not.
(3) signs of intracranial hypertension: 60% of patients on the skull X-ray shows signs of increased intracranial pressure manifested as saddle back decalcified skull back pressure within the board trace apparent brain, skull base change can have an equal performance of the skull in children suture separation
CT scan brain scan 2.CT sellar tumors appear as changes in those of non-enhanced scanning performance of solid tumors such as high density or density of images, calcified plaque as those for high-density cystic tumor containing cholesterol and low density image, CT value of -40 ~ 10Hu, cystic isodense. Lesion border and clear, rounded oval or lobulated, both sides of the lateral expansion of the Division. Enhanced scan in about 2 / 3 of cases may have different degrees of enhancement, CT values increased 12 ~ 14Hu cystic craniopharyngioma a ring or ring enhancement and central low density area without enhancement enhancement, a small number of craniopharyngioma calcified cysts do not generally have enhanced and strengthened the three performance enhancing sellar tumors can be diagnosed with craniopharyngioma (Figure 12)Cystic craniopharyngioma 4.MRI Duoshuo was part of the material contained in a short T1 and long T2, but also showed long T1 and long T2 images, the T1 weighted images showed low signal on T2 weighted images showed high signal; the case of substantive craniopharyngioma is elongated with the long T1 T2. Calcified plaques showed low signal areas.
CT and MRI examination in the diagnosis of the two important examination can show the tumor location, size, whether or cystic brain tumor invasion of the neighboring case, if there is hydrocephalus. In general, MRI in the structure of the tumor and its adjacent brain tissue (such as the optic chiasm) priority over the relationship between CT but he did not like CT showed calcification.
5. Intraventricular contrast ventriculography due to tumor sizes can clearly show the impact of tumor to the skull base and changes in arterial very helpful for surgical tumor cysts and the ventricle is interlinked to the same time line ventriculography can direct puncture into the tumor cavity
6. Gas gas Mai craniopharyngioma brain imaging brain imaging was 100% positive rate
7. Electroencephalography in the frontal wave, or a wide range of or waves mainly related to check:> thyroid stimulating hor vasopre prola ins luteinizing hormone therapy:
1. Surgical treatment of craniopharyngioma surgery is the preferred treatment. The purpose of surgical removal of the tumor by the tumor on the optic nerve to lift the cross and lifted the pressure of other nerve tissue of increased intracranial pressure on 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 cupping network. Craniopharyngioma is benign because, in addition to some of the pituitary stalk and optic chiasm gray tubercle, hypothalamus, and so somewhere in the end of the third ventricle and the surrounding tissue adhesion outside the structure of the majority of glial reaction or arachnoid border demarcation in principle, should strive to achieve complete resection in patients, especially children, to prevent the recurrence of small intrasellar craniopharyngioma particular type of tumor usually taken transsphenoidal procedure, and large tumors should be taken to transcranial surgical general, the success of the surgery can be effective relieve pressure caused by optic chiasm visual acuity, visual field changes, and high intracranial pressure can cause headaches and other symptoms that pituitary function was restored. However, many around the saddle on the type of craniopharyngioma and brain tissue (especially Mai is the hypothalamus) closely linked to increased difficulty of surgery for these patients do not insist on complete resection can be taken to partial resection, partial resection of the disadvantage is that the recurrence rate high. According to tumor location, size, shape, degree of calcification, and cyst location of some of the relationship with the surrounding tissue and accessible surgical cerebrospinal fluid pathways and other factors need to choose a different approach or way and have their own advantages and disadvantages.
(1) the amount of the end of approach: the main structure can be exposed to the optic nerve, chiasm, internal carotid artery, anterior cerebral artery for the optic chiasm pituitary stalk and other post within the saddle on the saddle or the saddle on the growth of large tumors prior to the suprachiasmatic The appearance of tumor growth ventricle approach can be further divided into several different surgical procedures: such as surgical or under through the optic chiasm to the optic chiasm, if pre-resection of tuberculum sellae and sphenoid between the surgical plate to reach the optic nerve or open surgical end plate and from the optic nerve or the carotid artery between the optic tract to reach the tumor were selected.
(2) pterional: The temporal approach similar to the end, but the path is the shortest direct route to the saddle area. Carotid artery can be exposed to the anterior cerebral artery and the optic tract optic nerve, optic chiasm, and the rear under the pituitary stalk, the end of the third ventricle, cerebral peduncle between the nest and on the slopes, etc., within the saddle for the saddle or saddle on the side of growth rear under the optic chiasm and optic chiasm tumor appearance between the pool ventricle. The approach most widely used is the main method of surgical removal of craniopharyngioma.
(3) end plate into the Road: The amount under the unilateral pterional approach and double the amount of interhemispheric approach can be reached after the optic chiasm and open end plate, exposed to the third ventricular extension of the tumor so that the approach for pre-saddle on the optic chiasm optic chiasm after the growth of indoor appearance of brain tumors.
(4) by 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: separation of unilateral fornix; separation chamber between the hole next to a vein; to enter by the choroid plexus; isolated brain vein.
(5) Transsphenoidal: fully in the saddle or saddle in the saddle within the mild growth or the growth of the tumor to the sphenoid sinus in transsphenoidal approach can be used
(6) other approaches and methods: for all times to remove the tumor before surgery to be carried out in phases, such as transcranial resection of suprasellar part of the tumor, then elective transsphenoidal resection of intrasellar part of the tumor, or for the removal of giant tumors of two or more taken into Way of the combined approach
In general the choice of surgical approach, or axial external approach through the central axis than the unilateral approach or a bilateral approach is more desirable approach. In order to achieve tumor removal should be avoided where the location of functional tissue surgery microscopy a distinction should be adopted and the level of protection and the arachnoid interface, it is a good safe removal of the tumor after the tumor is usually first exposed to puncture the tumor cyst fluid extraction, and create Surgical separation of the tumor capsule and the arachnoid space and to separate the tumor capsule during re-narrowing after resection of the tumor to be followed by coagulation and separation of tumor blood supply. 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 tumor almost no adhesion is not large artery close, but in the separation of the basilar artery and brain After the artery when the tumor is very careful because there are usually more closely adhesion of tumor calcification are often located in the bottom of the optic chiasm and optic nerve in particular often below the line to be removed after the first crush. Sometimes this part of the tumor calcification and nerves, blood vessels, removal of the pituitary stalk and so difficult to close long-adhesion to the bottom of the third ventricle tumor often makes cupping network of local glial reaction layer formation, separation wall should be carried out within this layer, if the third ventricle has a layer of glial layer was thinning (with a thicker part of the nucleus has been over the top) of the layers 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 nerve tissue and blood vessels


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