Efficacy analysis of endoscopic endonasal and craniotomy surgery in the treatment of craniopharyngioma Based on QST Classification
10.3969/j.issn.1002-0152.2025.02.002
- VernacularTitle:基于QST分型内镜经鼻与开颅手术治疗颅咽管瘤疗效分析
- Author:
Chunlin ZHANG
1
;
Changzhen JIANG
;
Jun FU
;
Zhicheng WANG
;
Jianyu ZHU
;
Wenjian FAN
;
Xianjun CHEN
;
Wanhai LI
;
Wenwei LUO
;
Wenpei CHEN
;
Jinsheng HUANG
;
Xiaorong YAN
Author Information
1. 福建医科大学附属南平第一医院神经外科(南平 353000)
- Publication Type:Journal Article
- Keywords:
Craniopharyngioma;
QST classification;
Transcranial approach;
Endonasal approach;
Complication analysis
- From:
Chinese Journal of Nervous and Mental Diseases
2025;51(2):72-81
- CountryChina
- Language:Chinese
-
Abstract:
Objective This study aims to explore the efficacy and complication rates of the transcranial approach(TCA)and extended endoscopic endonasal approach(EEEA)for the treatment of craniopharyngiomas based on the QST classification,providing a scientific reference for clinical decision-making on surgical approach.Methods A total of 151 patients who underwent craniopharyngioma surgery at our center from January 2018 to December 2023 were enrolled.The patients were categorized into Q-CP(suprasellar type),S-CP(infundibular type),and T-CP(tuberal type)according to the QST classification.Systematic collection and analysis were performed on the outcomes of TCA and EEEA treatments,respectively.The differences in effectiveness between the two approaches were evaluated based on the QST classification.Results The improvement rate of visual symptoms was overall higher in the EEEA group than in the TCA group(59.1%vs.36.5%,P=0.006),and the visual deterioration rate was lower(3.0%vs.14.1%,P=0.006).However,the incidence of cerebrospinal fluid leakage was higher in the EEEA group(15.2%vs.3.5%,χ2=4.986,P=0.026).The incidence of postoperative seizures(8.2%vs.0,P=0.019),brain contusions(10.6%vs.0,P=0.005),and subdural hematoma(9.4%vs.0%,P=0.01)was higher in the TCA group.For patients with Q-CP type,the EEEA group had a higher rate of total tumor resection(92.9%vs.65.2%,P=0.025)and a lower recurrence rate(3.6%vs.21.7%,P=0.047),with shorter hospital stays and lower postoperative costs.The TCA group had higher intraoperative blood loss in this type(300 mL vs.200 mL,Z=-2.261,P=0.024).For S-CP type patients,the EEEA group showed a higher rate of total tumor resection(91.3%vs.74.2%)and a lower recurrence rate(0 vs.12.9%,P=0.031),with lower postoperative hospital costs.In T-CP type,due to the deeper location,EEEA showed limitations in protecting hypothalamic function and the TCA group had a better postoperative hypothalamic function score(P=0.035).Conclusion Based on QST classification,EEEA has advantages in Q-CP and S-CP types and is recommended as the preferred surgical procedure;In the T-CP type,TCA surgery is more helpful in protecting hypothalamic function.
