経鼻内視鏡手術を中心とした小児頭蓋咽頭腫に対する積極的な病変切除と治療成績
小児頭蓋咽頭腫に対する外科的切除では，摘出率の向上により再発率を抑え，加えて視機能温存や周囲組織への障害を最小限にすることが必要であるが，病変が血管穿通枝，視神経視交叉や視床下部と近接しているため，安全に摘出することは容易ではない．近年，頭蓋咽頭腫に対しては経鼻内視鏡手術が基本アプローチとなっており，小児症例においてもその傾向にある．当院では2014年4月以降経鼻内視鏡下での積極的な病変摘出を基本方針としており，当院での小児症例に対する経鼻内視鏡手術を中心とした病変切除の実際と治療成績について報告する．...
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| Published in | 小児の脳神経 Vol. 49; no. 1; pp. 26 - 32 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本小児神経外科学会
2024
日本小児神経外科学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0387-8023 2435-824X |
| DOI | 10.34544/jspn.49.1_26 |
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| Abstract | 小児頭蓋咽頭腫に対する外科的切除では，摘出率の向上により再発率を抑え，加えて視機能温存や周囲組織への障害を最小限にすることが必要であるが，病変が血管穿通枝，視神経視交叉や視床下部と近接しているため，安全に摘出することは容易ではない．近年，頭蓋咽頭腫に対しては経鼻内視鏡手術が基本アプローチとなっており，小児症例においてもその傾向にある．当院では2014年4月以降経鼻内視鏡下での積極的な病変摘出を基本方針としており，当院での小児症例に対する経鼻内視鏡手術を中心とした病変切除の実際と治療成績について報告する． |
|---|---|
| AbstractList | 「要旨」小児頭蓋咽頭腫に対する外科的切除では, 摘出率の向上により再発率を抑え, 加えて視機能温存や周囲組織への障害を最小限にすることが必要であるが, 病変が血管穿通枝, 視神経視交叉や視床下部と近接しているため, 安全に摘出することは容易ではない. 近年, 頭蓋咽頭腫に対しては経鼻内視鏡手術が基本アプローチとなっており, 小児症例においてもその傾向にある. 当院では2014年4月以降経鼻内視鏡下での積極的な病変摘出を基本方針としており, 当院での小児症例に対する経鼻内視鏡手術を中心とした病変切除の実際と治療成績について報告する. 小児頭蓋咽頭腫に対する外科的切除では，摘出率の向上により再発率を抑え，加えて視機能温存や周囲組織への障害を最小限にすることが必要であるが，病変が血管穿通枝，視神経視交叉や視床下部と近接しているため，安全に摘出することは容易ではない．近年，頭蓋咽頭腫に対しては経鼻内視鏡手術が基本アプローチとなっており，小児症例においてもその傾向にある．当院では2014年4月以降経鼻内視鏡下での積極的な病変摘出を基本方針としており，当院での小児症例に対する経鼻内視鏡手術を中心とした病変切除の実際と治療成績について報告する． |
| Author | 森迫, 拓貴 池上, 方基 坂本, 博昭 一ノ瀬, 努 田上, 雄大 後藤, 剛夫 |
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| References | [14] Hofmann BM, Höllig A, Strauss C, Buslei R, Buchfelder M, Fahlbusch R: Results after treatment of craniopharyngiomas: further experiences with 73 patients since 1997. J Neurosurg 116: 373-384, 2012. [29] Šteňo J, Bízik I, Šteňo A, Matejčík V: Recurrent craniopharyngiomas in children and adults: long-term recurrence rate and management. Acta Neurochir（Wien） 156: 113-122, 2014. [4] Chen W, Gardner PA, Branstetter BF, Liu SD, Chang YF, Snyderman CH, Goldstein JA, Tyler-Kabara EC, Schuster LA: Long-term impact of pediatric endoscopic endonasal skull base surgery on midface growth. J Neurosurg Pediatr 23: 523-530, 2019. [1] Algattas H, Setty P, Goldschmidt E, Wang EW, Tyler-Kabara EC, Snyderman CH, Gardner PA: Endoscopic endonasal approach for craniopharyngiomas with intraventricular extension: case series, long-term outcomes, and review. World Neurosurg 144: e447-e459, 2020 [16] Koutourousiou M, Gardner PA, Fernandez-Miranda JC, Tyler- Kabara EC, Wang EW, Snyderman CH: Endoscopic endonasal surgery for craniopharyngiomas: surgical outcome in 64 patients. J Neurosurg 119: 1194-1207, 2013. [20] 森迫拓貴，後藤剛夫，坂本博昭，大畑建治 : 経鼻内視鏡手術において小児頭蓋咽頭腫を積極的に切除するための工夫．小児の脳神経45: 17-24, 2020. [13] Henderson F Jr, Schwartz TH: Update on management of craniopharyngiomas. J Neurooncol. 156: 97-108, 2022. [11] Gautier A, Godbout A, Grosheny C, Tejedor I, Coudert M, Courtillot C, Jublanc C, De Kerdanet M, Poirier JY, Riffaud L, et al: Markers of recurrence and long-term morbidity in craniopharyngioma: a systematic analysis of 171 patients. J Clin Endocrinol Metab 97: 1258-1267, 2012. [17] La Corte E, Younus I, Pivari F, Selimi A, Ottenhausen M, Forbes JA, Pisapia DJ, Dobri GA, Anand VK, Schwartz TH: BRAF V600E mutant papillary craniopharyngiomas: a single-institutional case series. Pituitary 21: 571-583, 2018. [15] Kassam AB, Gardner PA, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM: Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum. J Neurosurg 108: 715-728, 2008. [19] Morisako H, Goto T, Goto H, Bohoun CA, Tamrakar S, Ohata K: Aggressive surgery based on an anatomical subclassification of craniopharyngiomas. Neurosurg Focus 41: E10, 2016. [10] Gardner PA, Kassam AB, Snyderman CH, Carrau RL, Mintz AH, Grahovac S, Stefko S: Outcomes following endoscopic, expanded endonasal resection of suprasellar craniopharyngiomas: a case series. J Neurosurg 109: 6-16, 2008. [18] Matsuo T, Kamada K, Izumo T, Nagata I: Indication and limitations of endoscopic extended transsphenoidal surgery for craniopharyngioma. Neurol Med Chir（Tokyo） 54: 974-982, 2014. [6] Conger A, Zhao F, Wang X, Eisenberg A, Griffiths C, Esposito F, Carrau RL, Barkhoudarian G, Kelly DF: Evolution of the graded repair of CSF leaks and skull base defects in endonasal endoscopic tumor surgery: trends in repair failure and meningitis rates in 509 patients. J Neurosurg 11; 130: 861-875, 2018. [12] Godil SS, Tosi U, Gerges M, Garton ALA, Dobri GA, Kacker A, Tabaee A, Anand VK, Schwartz TH: Long-term tumor control after endoscopic endonasal resection of craniopharyngiomas: comparison of gross-total resection versus subtotal resection with radiation therapy. J Neurosurg 136: 1347-1355, 2021. [27] Parasher AK, Lerner DK, Glicksman JT, Storm PB, Lee JYK, Vossough A, Brooks S, Palmer JN, Adappa ND: The impact of expanded endonasal skull base surgery on midfacial growth in pediatricpatients. Laryngoscope 130: 338-342, 2020. [31] Younus I, Forbes JA, Ordóñez-Rubiano EG, Avendano-Pradel R, La Corte E, Anand VK, Schwartz TH: Radiation therapy rather than prior surgery reduces extent of resection during endonasal endoscopic reoperation for craniopharyngioma. Acta Neurochir（Wien） 160: 1425-1431, 2018. [26] Ordóñez-Rubiano EG, Forbes JA, Morgenstern PF, Arko L, Dobri GA, Greenfield JP, Souweidane MM, Tsiouris AJ, Anand VK, Kacker A, et al: Preserve or sacrifice the stalk? Endocrinological outcomes, extent of resection, and recurrence rates following endoscopic endonasal resection of craniopharyngiomas. J Neurosurg 1: 1-9, 2018. [30] Wu J, Pan C, Xie S, Tang B, Fu J, Wu X, Tong Z, Wu B, Yang Y, Ding H, et al: A propensity-adjusted comparison of endoscopic endonasal surgery versus transcranial micro- surgery for pediatric craniopharyngioma: a single-center study. J Neurosurg Pediatr 29: 325-334, 2022. [3] Cavallo LM, Frank G, Cappabianca P, Solari D, Mazzatenta D, Villa A, Zoli M, D’Enza AI, Esposito F, Pasquini E: The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients. J Neurosurg 121: 100-113, 2014. [8] Fahlbusch R, Hofmann BM: Surgical management of giant craniopharyngiomas. Acta Neurochir（Wien）. 150: 1213-1226, 2008. [24] 大畑裕紀，森迫拓貴，一ノ瀬努，坂本博昭，後藤剛夫 : 大型分葉状小児頭蓋咽頭腫に対して経鼻内視鏡下経頭蓋顕微鏡下同時腫瘍摘出術が有用であった1例．小児の脳神経47: 36-40, 2022. [22] Ogino A, Niranjan A, Kano H, Flickinger JC, Lunsford LD: Optimizing stereotactic radiosurgery in patients with recurrent or residual craniopharyngiomas. J Neurooncol 154: 113-120, 2021. [7] Dhandapani S, Singh H, Negm HM, Cohen S, Souweidane MM, Greenfield JP, Anand VK, Schwartz TH: Endonasal endoscopic reoperation for residual or recurrent craniopharyngiomas. J Neurosurg 126: 418-430, 2017. [2] Bobeff EJ, Mathios D, Mistry AA, Dobri GA, Souweidane MM, Anand VK, Tabaee A, Kacker A, Greenfield JP, Schwartz TH: Predictors of extent of resection and recurrence following endoscopic endonasal resection of craniopharyngioma. J Neurosurg 28: 1-12, 2023. [21] Ogawa Y, Niizuma K, Tominaga T: Recovery from diabetes insipidus and preservation of thyroid function after cranio- pharyngioma removal and pituitary stalk sectioning. Clin Neurol Neurosurg 162: 36-40, 2017. [23] Ogiwara T, Nagm A, Hasegawa T, Hanaoka Y, Ichinose S, Goto T, Hongo K: Pitfalls of skull base reconstruction in endoscopic endonasal approach. Neurosurg Rev 42: 683-689, 2019. [25] Omay SB, Chen YN, Almeida JP, Ruiz-Treviño AS, Boockvar JA, Stieg PE, Greenfield JP, Souweidane MM, Kacker A, Pisapia DJ, et al: Do craniopharyngioma molecular signatures correlate with clinical characteristics? J Neurosurg 128: 1473-1478, 2018. [28] Patel KS, Raza SM, McCoul ED, Patrona A, Greenfield JP, Souweidane MM, Anand VK, Schwartz TH: Long-term quality of life after endonasal endoscopic resection of adult craniopharyngiomas. J Neurosurg 123: 571-580, 2015. [5] Chivukula S, Koutourousiou M, Snyderman CH, Fernandez- Miranda JC, Gardner PA, Tyler-Kabara EC: Endoscopic endonasal skull base surgery in the pediatric population. J Neurosurg Pediatr 11: 227-241, 2013. [9] Fan J, Liu Y, Pan J, Peng Y, Peng J, Bao Y, Nie J, Wang C, Qiu B, Qi S: Endoscopic endonasal versus transcranial surgery for primary resection of craniopharyngiomas based on a new QST classification system: a comparative series of 315 patients. J Neurosurg 135: 1298-1309, 2021. |
| References_xml | – reference: [20] 森迫拓貴，後藤剛夫，坂本博昭，大畑建治 : 経鼻内視鏡手術において小児頭蓋咽頭腫を積極的に切除するための工夫．小児の脳神経45: 17-24, 2020. – reference: [31] Younus I, Forbes JA, Ordóñez-Rubiano EG, Avendano-Pradel R, La Corte E, Anand VK, Schwartz TH: Radiation therapy rather than prior surgery reduces extent of resection during endonasal endoscopic reoperation for craniopharyngioma. Acta Neurochir（Wien） 160: 1425-1431, 2018. – reference: [29] Šteňo J, Bízik I, Šteňo A, Matejčík V: Recurrent craniopharyngiomas in children and adults: long-term recurrence rate and management. Acta Neurochir（Wien） 156: 113-122, 2014. – reference: [25] Omay SB, Chen YN, Almeida JP, Ruiz-Treviño AS, Boockvar JA, Stieg PE, Greenfield JP, Souweidane MM, Kacker A, Pisapia DJ, et al: Do craniopharyngioma molecular signatures correlate with clinical characteristics? J Neurosurg 128: 1473-1478, 2018. – reference: [18] Matsuo T, Kamada K, Izumo T, Nagata I: Indication and limitations of endoscopic extended transsphenoidal surgery for craniopharyngioma. Neurol Med Chir（Tokyo） 54: 974-982, 2014. – reference: [4] Chen W, Gardner PA, Branstetter BF, Liu SD, Chang YF, Snyderman CH, Goldstein JA, Tyler-Kabara EC, Schuster LA: Long-term impact of pediatric endoscopic endonasal skull base surgery on midface growth. J Neurosurg Pediatr 23: 523-530, 2019. – reference: [21] Ogawa Y, Niizuma K, Tominaga T: Recovery from diabetes insipidus and preservation of thyroid function after cranio- pharyngioma removal and pituitary stalk sectioning. Clin Neurol Neurosurg 162: 36-40, 2017. – reference: [19] Morisako H, Goto T, Goto H, Bohoun CA, Tamrakar S, Ohata K: Aggressive surgery based on an anatomical subclassification of craniopharyngiomas. Neurosurg Focus 41: E10, 2016. – reference: [9] Fan J, Liu Y, Pan J, Peng Y, Peng J, Bao Y, Nie J, Wang C, Qiu B, Qi S: Endoscopic endonasal versus transcranial surgery for primary resection of craniopharyngiomas based on a new QST classification system: a comparative series of 315 patients. J Neurosurg 135: 1298-1309, 2021. – reference: [15] Kassam AB, Gardner PA, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM: Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum. J Neurosurg 108: 715-728, 2008. – reference: [3] Cavallo LM, Frank G, Cappabianca P, Solari D, Mazzatenta D, Villa A, Zoli M, D’Enza AI, Esposito F, Pasquini E: The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients. J Neurosurg 121: 100-113, 2014. – reference: [10] Gardner PA, Kassam AB, Snyderman CH, Carrau RL, Mintz AH, Grahovac S, Stefko S: Outcomes following endoscopic, expanded endonasal resection of suprasellar craniopharyngiomas: a case series. J Neurosurg 109: 6-16, 2008. – reference: [8] Fahlbusch R, Hofmann BM: Surgical management of giant craniopharyngiomas. Acta Neurochir（Wien）. 150: 1213-1226, 2008. – reference: [12] Godil SS, Tosi U, Gerges M, Garton ALA, Dobri GA, Kacker A, Tabaee A, Anand VK, Schwartz TH: Long-term tumor control after endoscopic endonasal resection of craniopharyngiomas: comparison of gross-total resection versus subtotal resection with radiation therapy. J Neurosurg 136: 1347-1355, 2021. – reference: [22] Ogino A, Niranjan A, Kano H, Flickinger JC, Lunsford LD: Optimizing stereotactic radiosurgery in patients with recurrent or residual craniopharyngiomas. J Neurooncol 154: 113-120, 2021. – reference: [2] Bobeff EJ, Mathios D, Mistry AA, Dobri GA, Souweidane MM, Anand VK, Tabaee A, Kacker A, Greenfield JP, Schwartz TH: Predictors of extent of resection and recurrence following endoscopic endonasal resection of craniopharyngioma. J Neurosurg 28: 1-12, 2023. – reference: [11] Gautier A, Godbout A, Grosheny C, Tejedor I, Coudert M, Courtillot C, Jublanc C, De Kerdanet M, Poirier JY, Riffaud L, et al: Markers of recurrence and long-term morbidity in craniopharyngioma: a systematic analysis of 171 patients. J Clin Endocrinol Metab 97: 1258-1267, 2012. – reference: [14] Hofmann BM, Höllig A, Strauss C, Buslei R, Buchfelder M, Fahlbusch R: Results after treatment of craniopharyngiomas: further experiences with 73 patients since 1997. J Neurosurg 116: 373-384, 2012. – reference: [26] Ordóñez-Rubiano EG, Forbes JA, Morgenstern PF, Arko L, Dobri GA, Greenfield JP, Souweidane MM, Tsiouris AJ, Anand VK, Kacker A, et al: Preserve or sacrifice the stalk? Endocrinological outcomes, extent of resection, and recurrence rates following endoscopic endonasal resection of craniopharyngiomas. J Neurosurg 1: 1-9, 2018. – reference: [1] Algattas H, Setty P, Goldschmidt E, Wang EW, Tyler-Kabara EC, Snyderman CH, Gardner PA: Endoscopic endonasal approach for craniopharyngiomas with intraventricular extension: case series, long-term outcomes, and review. World Neurosurg 144: e447-e459, 2020 – reference: [27] Parasher AK, Lerner DK, Glicksman JT, Storm PB, Lee JYK, Vossough A, Brooks S, Palmer JN, Adappa ND: The impact of expanded endonasal skull base surgery on midfacial growth in pediatricpatients. Laryngoscope 130: 338-342, 2020. – reference: [5] Chivukula S, Koutourousiou M, Snyderman CH, Fernandez- Miranda JC, Gardner PA, Tyler-Kabara EC: Endoscopic endonasal skull base surgery in the pediatric population. J Neurosurg Pediatr 11: 227-241, 2013. – reference: [13] Henderson F Jr, Schwartz TH: Update on management of craniopharyngiomas. J Neurooncol. 156: 97-108, 2022. – reference: [17] La Corte E, Younus I, Pivari F, Selimi A, Ottenhausen M, Forbes JA, Pisapia DJ, Dobri GA, Anand VK, Schwartz TH: BRAF V600E mutant papillary craniopharyngiomas: a single-institutional case series. Pituitary 21: 571-583, 2018. – reference: [6] Conger A, Zhao F, Wang X, Eisenberg A, Griffiths C, Esposito F, Carrau RL, Barkhoudarian G, Kelly DF: Evolution of the graded repair of CSF leaks and skull base defects in endonasal endoscopic tumor surgery: trends in repair failure and meningitis rates in 509 patients. J Neurosurg 11; 130: 861-875, 2018. – reference: [24] 大畑裕紀，森迫拓貴，一ノ瀬努，坂本博昭，後藤剛夫 : 大型分葉状小児頭蓋咽頭腫に対して経鼻内視鏡下経頭蓋顕微鏡下同時腫瘍摘出術が有用であった1例．小児の脳神経47: 36-40, 2022. – reference: [30] Wu J, Pan C, Xie S, Tang B, Fu J, Wu X, Tong Z, Wu B, Yang Y, Ding H, et al: A propensity-adjusted comparison of endoscopic endonasal surgery versus transcranial micro- surgery for pediatric craniopharyngioma: a single-center study. J Neurosurg Pediatr 29: 325-334, 2022. – reference: [23] Ogiwara T, Nagm A, Hasegawa T, Hanaoka Y, Ichinose S, Goto T, Hongo K: Pitfalls of skull base reconstruction in endoscopic endonasal approach. Neurosurg Rev 42: 683-689, 2019. – reference: [28] Patel KS, Raza SM, McCoul ED, Patrona A, Greenfield JP, Souweidane MM, Anand VK, Schwartz TH: Long-term quality of life after endonasal endoscopic resection of adult craniopharyngiomas. J Neurosurg 123: 571-580, 2015. – reference: [7] Dhandapani S, Singh H, Negm HM, Cohen S, Souweidane MM, Greenfield JP, Anand VK, Schwartz TH: Endonasal endoscopic reoperation for residual or recurrent craniopharyngiomas. J Neurosurg 126: 418-430, 2017. – reference: [16] Koutourousiou M, Gardner PA, Fernandez-Miranda JC, Tyler- Kabara EC, Wang EW, Snyderman CH: Endoscopic endonasal surgery for craniopharyngiomas: surgical outcome in 64 patients. J Neurosurg 119: 1194-1207, 2013. |
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| Snippet | ... 「要旨」小児頭蓋咽頭腫に対する外科的切除では, 摘出率の向上により再発率を抑え, 加えて視機能温存や周囲組織への障害を最小限にすることが必要であるが, 病変が血管穿通枝, 視神経視交叉や視床下部と近接しているため, 安全に摘出することは容易ではない. 近年,... |
| SourceID | medicalonline jstage |
| SourceType | Publisher |
| StartPage | 26 |
| SubjectTerms | aggressive resection endoscopic endonasal approach (EEA) pediatric craniopharyngiomas |
| Title | 経鼻内視鏡手術を中心とした小児頭蓋咽頭腫に対する積極的な病変切除と治療成績 |
| URI | https://www.jstage.jst.go.jp/article/jspn/49/1/49_26/_article/-char/ja http://mol.medicalonline.jp/en/journal/download?GoodsID=co2socie/2024/004901/005&name=0026-0032j |
| Volume | 49 |
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| ispartofPNX | 小児の脳神経, 2024, Vol.49(1), pp.26-32 |
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