CAJ | 학술논문

目的对儿童颅咽管瘤患者术后认知功能变化进行前瞻性研究.方法根据术前MRI正中矢状位检查将病例分为三级(Type 0级、Type 1级、Type 2级),术前及术后半年左右分别进行认知功能检查.检查项目包括韦氏儿童智力测试(C-WISC)、汉诺塔测试、Stroop测试、数字划消测试.共22例有完整资料,男13例,女9例；平均10.5岁(6～16岁)；Type 0级4例,Type 1级4例,Type 2级14例.经额底入路4例,经纵裂入路7例,经胼胝体穹窿间入路10例,右额颞入路1例.结果 4例Type2级术后IQ成绩下降明显,均为经胼胝体入路；余病例术后IQ成绩较术前无明显下降.4例放疗患者术后注意集中指数1较术前差异有统计学意义(P =0.047).结论儿童颅咽管瘤患者术后出现认知功能受损的主要危险因素为肿瘤侵及下丘脑的程度、手术入路、放射治疗.
목적 대인동로인관류환자술후인지공능변화진행전첨성연구.방법 근거술전MRI정중시상위검사장병례분위삼급(Type 0급、Type 1급、Type 2급),술전급술후반년좌우분별진행인지공능검사.검사항목포괄위씨인동지력측시(C-WISC)、한낙탑측시、Stroop측시、수자화소측시.공22례유완정자료,남13례,녀9례；평균10.5세(6～16세)；Type 0급4례,Type 1급4례,Type 2급14례.경액저입로4례,경종렬입로7례,경변지체궁륭간입로10례,우액섭입로1례.결과 4례Type2급술후IQ성적하강명현,균위경변지체입로；여병례술후IQ성적교술전무명현하강.4례방료환자술후주의집중지수1교술전차이유통계학의의(P =0.047).결론 인동로인관류환자술후출현인지공능수손적주요위험인소위종류침급하구뇌적정도、수술입로、방사치료.
Objective To evaluate the perioperative cognitive changes in pediatric craniopharyngioma patients prospectively.Methods The patients were divided into three groups (Type 0,Type 1,and Type 2) depending on the degree of hypothalamic involvement on preoperative sagittal MRI images.The cognitive function of these patients were evaluated by four neuropsychological tests:WISC-R,Stroop test,Cancellation test,and Hanoi tower test before and four to nine months after tumor resection.The patients included 22 children (13 males and 9 females) with a mean age of 10.5 (6～16) years old during operation.The number of cases within the three groups was 4,4,and 14 respectively.4 out of 22 were operated through the subfrontal approach,7 through the translongitudinal fissure approach,10 through the transcallosal interforniceal approach,and 1 through the pterion approach.Results The IQ scores of 4 patients declined dramatically after tumor removal in the Type 2 group.However,there was no significant decline in IQ scores after surgery in the other patients.All 4 patients with IQ drops were operated through the transcollosal interforniceal approach.There was a significant difference in contributive index 1 between the 4 patients who received radiation treatment and the others who did not (P =0.047).Conclusions The risk factors,which may influence cognitive functions in children with craniopharyngiomas after surgery,are the degree of hypothalamic involvement,surgical approach,and radiation therapy.