T.S. Krasnova, E.S. Kuznetsova, N.K. Serova, L.A. Lazareva
(Burdenko Research Institute of Neurosurgery, Moscow)
Development of microsurgical technique for craniopharyngioma removal, carried out in the Burdenko Research Institute of Neurosurgery, was aimed at prolongation of survival of operated children. The analysis of results demonstrated better efficacy of operations and smaller postoperative mortality. One of the most important problems of today is survival duration and life prospects of operated children, i.e. their social adaptation.
The study goal was search for factors, effecting duration and quality of life of children, operated for craniopharyngiomas.
Materials and Methods. The research included analysis of surgery results (1), studying dynamics of vision impairment (2), assessment of neurological and endocrinous statuses (3), estimating dynamics of postoperative changes within cerebral structures and tumor remnants (4), studying cerebral blood flow with transcranial Doppler and SPECT, combined with radionuclide angiography.
We analyzed catamnestic data of 326 children, aged 9 months-15 years. A period of follow-up varied from 1 up to 27 years. The necessary information was obtained by carrying out clinical and X-ray studies, filling questionnaires, analyzing operation results and data of pre-and postoperative states of children. A neuropsychological examination according to Luriya A.R. allowed to assess adaptation potentialities after removal of craniopharyngiomas. The data were subject to mathematical processing for determining correlation between clinical-and-diagnostic indices.
There were 88 cases, who died during a period of long-term follow-up (1-27 years). Survival of 6-25 years and more was watched in 166 patients. They underwent total (68) and subtotal (98) removal of a tumor. Relapses occurred 2-3 years after intervention. All the cases were divided into 3 groups in compliance with a degree of social adaptation. They were as follows: group I – complete social adaptation (76), group II – cases, adapted for living with their family (115), group III – patients, requiring outside assistance and care (47).
1. Operation, performed at an early stage and against a background of good vision, prolonged survival and improved subsequent adaptation of a patient to a great extent.
2. Lifetime of children with removed craniopharyngiomas was directly dependent on operation efficacy and grew in their total removal.
3. An unfavorable factor, limiting adaptation, was manipulations on the structures of the third ventricle, as endocrinous disorders, especially in case of their inadequate correction, had a great effect on social adaptation.
4. Augmentation of liquorodynamics disorders in a remote period reduced a degree of adaptation.
5. The highest degree of adaptation was watched in group I and II, comprising more than 80% of cases.