[简讯]颅咽管瘤发出中国声音 漆松涛团队"基于QST分型的颅咽管瘤外科治疗"在美出版

Major Contributing editors (Left to right): Lu Yuntao, Pan Jun, Qi Songtao, Zhang Xi-an, Fan Jun

神外前沿讯，近日南方医科大学南方医院神经外科漆松涛教授团队的新书《神经外科前沿：颅咽管瘤—新分型和外科治疗》英文版，受美国最大图书机构Bentham science约稿出版发行。

此前，中国知名神经外科专家漆松涛教授，提出了对颅咽管瘤的QST分型，基于此分型，能够们针对不同起源及生长方式的肿瘤采用不同的外科治疗方式。

漆松涛教授对神外前沿表示：该书的出版标志着在颅咽管瘤这种十分困难的疾病领域，中国有了重要发言权。

此前，漆松涛教授在接受神外前沿专访时表示，个人对手术理念有一些感悟和系统的认识，就是以膜性概念为代表的新手术方法，并将出版这本《神经外科前沿：颅咽管瘤—新分型和外科治疗》。详见[更新]专访南方医院漆松涛: 颅咽管瘤治疗有误区  提出膜性神经外科学概念

漆松涛教授表示，以颅咽管瘤为例，从事这个领域的国际大牌专家很多，但始终治疗起来很困难，我认为是就是对颅咽管瘤的起源认识有错误，我们认为这基于肿瘤起源为基础结合膜性结构对颅咽管瘤生长方式的影响而建立的新分型，可以有效的指导颅咽管瘤的外科治疗，准确预测手术难度和预后。

关于本书

虽然颅咽管瘤是组织学良性的肿瘤，但其显示了一些恶性肿瘤的生物学行为，例如对周围组织的侵袭、反复复发和快速生长等。所有这些特点导致了在治疗这种肿瘤时，全世界神经外科医生都存在了较大的麻烦。自从1998年至今，我们神经外科共收治了超过600例的颅咽管瘤病人，同时收集并整理完善了详细的临床资料（包括完整的术前和术后的CT和MRI、术中录像、内分泌评估以及长期随访的结果）。正是基于上述的这些临床数据，并结合了术中所见和对于肿瘤和周围结构的解剖学研究，我们提出了颅咽管瘤的新形态学和相应的外科学分型。

此外，基于此分型，我们针对不同起源及生长方式的肿瘤采用了不同的外科治疗方式，而长期随访结果显示正确的手术入路选择，以及术中 43 34069 43 14942 0 0 2951 0 0:00:11 0:00:05 0:00:06 2951清晰的界定肿瘤和周围重要结构的手术界面，确实能降低肿瘤的复发。且在大多数病例中也提高了病人的生活质量。通过本书的撰写，我们希望从颅咽管瘤的流行病学、临床表现、外科学理解、手术理念、内分泌评估和围手术其处理等方面，将我们对该肿瘤的起源、生长方式、外科学处理和相关内分泌等的理解进行总结，并由其对于肿瘤-膜的相关关系，以及如何更好的发现肿瘤和神经血管结构的手术界面进行描述，希冀对颅咽管瘤的治疗能起到推动作用。 

整书437页，50余万字，包括300幅清晰的解剖、影像学和术中图片，200幅电脑绘制的示意图，并提供了超过50例的典型颅咽管瘤病例。另外对于儿童颅咽管瘤和复发颅咽管瘤，我们均将列出单独的章节进行描述。对比既往其它国内外的颅咽管瘤专著，本书从外科学治疗角度，更为详细的对肿瘤起源、生长、内分泌状态，外科学手术及围手术期处理进行阐述。 

以本书为基础，南方医院神经外科漆松涛主任团队，进一步结合了团队近期对颅咽管瘤基础研究和临床应用研究的新发现，撰写了颅咽管瘤治疗的中文书，不日也将出版付梓。

本书目录

CRANIOPHARYNGIOMA—— CLASSIFICATION AND SURGICAL TREATMENT

Chief Editor: Qi Song-tao

Contents

Section I  Introduction to Craniopharyngioma 

Chapter I History and Epidemiology of Craniopharyngioma (Lu Yun-tao)

Chapter II The Pituitary gland and Etiology of Craniopharyngioma (Lu Yun-tao)

Chapter III Pathology classification of Craniopharyngioma and its molecular aspects (Yan Xiao-rong, Liu Yi)

Chapter IV Current therapeutic situation (Liu Yi)

Chapter V Experimental Craniopharyngioma research (Huang Guang-long and Zhou Jie)

Section II  Surgical anatomy of Craniopharyngioma

Chapter I Anatomy based on pterional and it's extension approach for surgery of craniopharyngioma (Lu Yun-tao)

Chapter II Anatomy based on interhemispheric approach for surgery of craniopharyngioma (Lu Yun-tao)

Chapter III Anatomy based on transsphenoidal approach for surgery of craniopharyngioma (Lu Yun-tao)

Section III  Surgical treatment of Craniopharyngioma 

Chapter I Craniopharyngioma Classification: history and its merit (Lu Yun-tao, Pan Jun)

Chapter II Subdiaphragmatic craniopharyngioma “Type Q” (Pan Jun)

Chapter III Subarachnoid Cisternal craniopharyngioma “Type S” (Pan Jun)

Chapter IV Suprasellar infundibulotuberal Craniopharyngioma “Type T” (Pan Jun)

Chapter V Intra-ventricular craniopharyngioma? (Pan Jun, Lu Yun-tao)

Chapter VI Infra-sellar and Nasopharyngeal craniopharyngioma (Pan Jun)

Chapter VII Recurrent craniopharyngioma (Pan Jun)

Section IV  Endoncrinological evaluation and Follow-up 

Chapter I  Hypopituitarism in Craniopharyngioma (Ye Chun-ling, Peng Jun-xiang)

Chapter II Hypothalamus status evaluation (Ye Chun-ling, Peng Jun-xiang)

Section V  Clinical manifestation and management for Children 

Chapter I   The concept of pediatric craniopharyngioma (Pan Jun)

 Chapter II  Presenting manifestations in pediatric craniopharyngioma (Pan Jun)

 Chapter III  Morphological features of pediatric versus adult patients (Pan Jun)

 Chapter IV  Quality of life and neurocognitive evaluations (Pan Jun)

Section VI  Fifty typical cases 

Chapter I   Infradiaphragmatic craniopharyngioma (Pan Jun, Lu Yun-tao)

Chapter II  Subarachnoid cisternal craniopharyngioma (Pan Jun, Lu Yun-tao)

Chapter III  Infundibulo-tuberal craniopharyngioma (Pan Jun, Lu Yun-tao)

Afterword………………………………………………………………………………

Preface 前言

In the 30th years of last century, Dr. Harvey Cushing, the greatmaster of neurosurgery, stated that “craniopharyngioma(CP) is the most buffering problem to the neurosurgeon”. Although a century has since passed, this famouscomment has been used frequently until now, indicating that the refractorinessof CP continues to challenge both patients and doctors.

During the past 10 years,epidemiological data regarding brain tumors have revealed that CP accounts for6–9% of all intracranialtumors and 54% of pediatric tumors in the sellar region. Furthermore, theannual prevalence of CP within a given population was 1.3/million. The abovedata confirm that CP is not a rare type of tumor, but rather is a commonintracranial tumor in pediatric patients. 

Histopathologically, CP originates fromresidual embryonic Rathke’s cyst cells, which are associated with a benign tumor. However, giventhe extreme difficulty associated with surgical treatment, various treatmentsfor malignant cancers, such as conventional radiotherapy, stereotacticradiosurgery, internal radiation therapy, and chemotherapy, have been acceptedby many neurosurgery centers in different countries worldwide. Despite thisacceptance, the high rate of recurrence, low quality of life, and lowtumor-free survival rate associated with CP unfortunately have not beensignificantly altered. Taken together, these findings suggest that this benigntumor exhibits malignant biological behaviors. 

Undoubtedly, surgery is the optimaltreatment method for CP. In other words, CP is a strictly surgical disease, andthus surgery might be the only curative method. In light of the advanceddevelopment and applications of microsurgical techniques in the most recenthalf-century, radical surgical CP removal has become increasingly accepted byhigh-level skull base neurosurgeons, and several publications have reportedgross total CP removal rates exceeding 80%. However, given the deep location ofCPs in close proximity to vital structures, the high levels of difficultyassociated with surgical removal and risk during the perioperative periodremain major problems associated with surgical treatment. Regarding reasonablesurgical treatment methods for CP, several masters of neurosurgery, includingPascau, Yasargil, and Kassam, summarized large numbers of clinical cases andpublished several important papers in which they used their experiences topropose methods for selecting the appropriate surgical approach and bestintraoperative techniques. These authors also proposed several widelyinfluential clinical classifications of CP, which remain in current usage.Invariably, those classifications accounted for the relationship between thetumor and the third ventricle, and described the anatomical occupation as apurely radiological classification. It is difficult for an inexperiencedneurosurgeon to completely understand the true origin of CP, particularly thetrue relationship of the tumor with the hypothalamic structures. Terminologysuch as intra-extra-ventricular CP and non-strictly or strictlyintra-ventricular CP led to tremendous confusion regarding whether the surgicaltreatment of CP would inevitably injure the hypothalamic structures. As aresult, the concept of unresectable CP was proposed and is considered theprimary reason for the wide acceptance of radiotherapeutic and chemotherapeutictreatment of CP. 

Since 1998, our group has accumulatedexperience in the surgical treatment of CP, based on the principle of radicalgross total removal, in more than 500 cases. First, we paid more attention tothe anatomical location of the tumor, and subsequently we shifted our focus tothe various origins of CP and the relationships between tumors and surroundingvital structures during the development of the various types of CP.Interestingly, the clinical outcome improved dramatically. As a result, weproposed a new classification for CP, according to the stratification ofanatomical features and based on the tumor origin. 

A restored understanding of theanatomical details of CP and their applications resulted in the advanceddevelopment of surgical techniques and clinical treatments. Our histologicaland anatomical studies of the hypophyseal gland, pituitary stalk and thirdventricular floor provided a foundation for our clinical applications withregard to sellar region surgery, and comprise a highlighted feature of thisbook. Of course, a book containing such important clinical and experimentaldata could not have been completed only by the named authors. We thereforeoffer our appreciation for all students and observers who have ever studied atour clinical center, all technicians in our laboratory, and the secretaries inmy office. 

An understanding of CP, as well asdifficulties of perioperative treatment and long-term hormone substitution, arelikely to become strictly required for relevant workers, along with increasedpatience, thanksgiving and compassion. It is encouraging to note that thisattitude has been accepted, inherited, and forwarded by all members of ourteam. I believe that this quality will not only benefit patients, but will alsofill our own lives like a sunny and inspiring breeze. 

I dedicate this book to all patients andtheir families for placing their trust in us. In addition, we offer thegreatest appreciation to our unsung families for their tremendous anduncomplaining dedication.

Songtao Qi 

Department of Neurosurgery

Nanfang Neurosurgery Research Institution

Nanfang Hospital, Southern MedicalUniversity

1838 North Guangzhou Avenue

510515 Guangzhou China

作者简介

漆松涛，主任医师，教授，博士生导师，南方医科大学南方医院神经外科主任、南方神经外科研究所所长，中国计算机辅助外科分会副主任委员、中华医学会神经外科分会常委、全国小儿神经外科学组组长、广东省神经外科分会主任委员。一直从事神经外科的临床和科研工作，对颅脑疑难危险的颅底病变手术有很高的造诣，经手术治愈的病例遍布香港、澳门、台湾及美国、东南亚等，尤其对颅脑血管病及复杂高危疑难手术有自己独特的风格，是最受国内外同行推崇的专家之一。

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