The Endoscopic Endonasal Approach (EEA) in the Management of Recurrent Craniopharyngiomas
Notice bibliographique
Résumé
Background: Recurrent craniopharyngiomas remain a significant management problem. The choice of surgical approach, the timing and use of adjuvant therapy are controversial with no uniform accepted protocol. Objective: To report and evaluate our experience with the endoscopic endonasal approach (EEA) for resection of recurrent craniopharyngiomas. Patients and Methods: From a retrospective cohort of 40 consecutive patients who underwent 43 EEA procedures between 2006–2012, 21 patients (48.8%) had recurrent tumors. The clinico-radiological presentation, surgical results, visual, endocrinological and functional outcomes were evaluated and compared between primary and recurrent tumors. The median follow up period was 23 months. Results: The disease was recurrent following one transcranial (TC) procedure in 12 patients, one TC and one microscopic transsphenoidal procedure in 2 patients and one TC and one EEA in 2 patients. One patient had two previous TC surgeries and one microscopic transsphenoidal approach. Two patients had a TC procedure and an endoscopic cyst fenestration. One patient had two TC surgeries and one EEA. Three of the 21 patients with recurrent disease had previous radiotherapy. The mean age (40.6 vs 41.9 years), maximum tumor diameter (2.9 cm vs 3.3 cm) and preoperative Karnofsky performance status (KPS) score was similar in both primary and recurrent groups. (p>0.05) Preoperative panhypopituitarusm (13.6 vs 61.9%) and diabetes insipidus (13.6 vs 52.4%) was significantly higher in the recurrent group. ( p < 0.05) Recurrent tumors were mainly of type II and type III of the Pittsburgh Classification. Total resection was achieved in 77% with primary lesions but only in 10% with recurrent lesions ( p < 0.001). The postoperative visual improvement (100 Vs 86.6%) as well as worsening of vision (0 vs 5%) was comparable in both groups. Worsening of anterior pituitary (52.6 vs 50%) as well as posterior pituitary function (42.1 vs 40%) was similar in both groups. No patient had a postoperative KPS score of <80 in the primary group, where as 25% in the recurrent group had a postoperative KPS <80. ( p < 0.05) Conclusions: While there was no difference in the mean age at presentation, tumor size and preoperative KPS between primary and recurrent tumors, recurrent tumors presented with increased anterior and posterior pituitary deficits. In our series, recurrent surgery was associated with significantly lower rates of gross total resection. There were no statistical differences in visual outcomes, postoperative diabetes insipidus, and other surgical complication rates between patients with primary and recurrent tumors. A significantly higher number of patient s had a poorer KPS score at follow-up in the recurrent group. The endoscopic endonasal approach has a significant role to play in recurrent cranioppharyngiomas especially if the original procedure was a TC approach and should be integrated in the overall management of these challenging lesions.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».