The first case of craniopharyngioma resection in children under nasal endoscope is successful in Chi

        Craniopharyngioma is one of the most common intracranial tumors in children. Although it is a benign tumor, the craniotomy used in the past has many disadvantages such as large trauma, long operation time, and many postoperative complications.At the same time, due to the deeper growth position of craniopharyngiomas and the low total surgical resection rate, they have high recurrence and low tumor-free long-term survival.This also makes it the only benign tumor that has been crowned with a malignant outcome. It is also a benign tumor of the nervous system that frustrates neurosurgeons.

  With the advancement of technology, in recent years, the endonasal sphenoidal nerve endoscopic resection of craniopharyngiomas has made gratifying progress.This minimally invasive surgical approach brings hope for complete craniopharyngioma from another completely new perspective.Due to the difficulty of this approach, children have small nostrils and poor development of the sphenoid sinus. Therefore, they are clinically adult applications and have not yet been implemented in children in China.

  Recently, the team led by the National Children's Medical Center and the director of neurosurgery at the Pediatric Hospital Affiliated to Fudan University successfully completed the first neuroendoscopic craniopharyngioma resection in children. After more than two hours, most of the internal tumors in the children's skull were removed, and the optic nerves of the children were protected to the greatest extent.Visual acuity was not affected and postoperative recovery was rapid.

  Risk of craniotomy and slow recovery

  The 6-year-old boy Gaga (a pseudonym) went to the hospital for fever and nosebleeds. He was finally diagnosed as a craniopharyngioma at the National Children's Medical Center and Pediatric Hospital. After imaging examination, he found that the saddle area was occupied by the pituitary stalk. And pressure at the optic chiasm."

  There are two peaks of craniopharyngioma. The peak of children is between 5 and 15 years old. The peak of adults is about 40 years old. The main clinical manifestations are headache and vomiting due to the symptoms of increased intracranial pressure, accompanied by visual disturbances of vision. As well as symptoms of endocrine dysfunction such as growth retardation, diabetes insipidus, central obesity, and dysplastic secondary sexual characteristics.

  Because of its deep position and adjacent to an important structure, craniopharyngiomas are complex and difficult to perform. In neurosurgery, they are known as crown jewels.Therefore, Harvey Cushing, the famous neurosurgeon's originator, asserted: "Unless there is a technique that can destroy the tumor in situ and make it static, the mortality of craniopharyngioma will remain at a high level."

  The treatment of craniopharyngioma is mainly surgical treatment.According to Professor Li Wei, the previous craniotomy was traumatized.Need to separate the normal brain tissue or cut the normal brain tissue to achieve the tumor, the damage is large, long operation time, high risk, postoperative complications.The difficulty of craniopharyngioma surgery and the high risk of perioperative period make the total resection rate of the surgery greatly different. Most of the reported total resection rates are between 25% and 75%.

  The first case of craniopharyngioma resection in children under nasal endoscope is successful in China

   Gaga's tumors have obviously pressed the optic chiasm and must be treated as soon as possible.Under the Multidisciplinary Discussion of the Neurosurgery of Pediatric Hospital Affiliated to Fudan University, Neurosurgery of Huashan Hospital Affiliated to Fudan University, and  the Endocrinology, Anesthesia, and Operation Room of Pediatric Hospital,Assessing surgical procedures and possible postoperative complications and management, the experts eventually reached a consensus that they should undergo neuroendoscopic resection of the tumor.In recent years, there have been reports of the removal of this type of tumor by nasal endoscopic surgery under a neuroendoscope.However, due to the difficulty of this approach, children have small nostrils and poor development of the sphenoid sinus. Therefore, they are all adult applications in clinical practice. Children have not yet performed such operations in China. Foreign cases have only seen scattered cases.

  Under the cooperation of the Department of Neurosurgery and Pediatric Hospital Neurosurgery at Huashan Hospital.The endoscope enters from the nostril and enters the bottom of the tumor through the base of the skull. Under the endoscope, the capsule at the bottom of the tumor is first incised to fully expose the tumor tissue. The tumor tissue then cuts the tumor from the middle and sucks the internal cyst fluid.Then under the guidance of the brain endoscope, the tumor tissue was scraped off in turn. "The brain endoscope can penetrate deep into the tumor and clearly shows the internal conditions of the tumor.Therefore, the internal tissue of the entire tumor cavity can be relatively cleanly removed, which greatly reduces the tumor tissue residue and also reduces the chance of recurrence.”Professor Li Wei said that because the surgical method can provide clear panoramic images of the surgical area, the anatomical structure is exposed clearly, and the important structure of the tumor and the surrounding can be clearly displayed in all directions, so that the tumor can be maximally excised and the damage possibility to normal nerve vessels can be reduced.

  More than two hours of surgery, most of the children's intracranial tumors were removed, and the children's optic nerves were protected to the maximum extent. Professor Li Hao pleased to say that the children's vision after operation has no effect, the second day after the operation, the children can sit up, and normal diet, no effect on endocrine function.

  The first case of pediatric craniopharyngioma resection under nasal endoscope in the Department of Neurosurgery of Pediatric Hospital opened a milestone in the surgical treatment of pediatric craniopharyngioma, which not only reduced the damage of normal brain tissue in children, but also reduced children’s similar tumors surgical injury,opens up new directions for the treatment of pediatric craniopharyngiomas.