Does the choice of surgical approach to insert an intratumoral catheter influence the results of intratumoral cystic treatment?

Abstract

Background In the literature, only a few articles are related to the surgical approach for insertion of an intratumoral catheter. No one has evaluated the complications related to the different surgical techniques for the treatment of pediatric cystic craniopharyngiomas. Methods A cooperative, multicenter (France and Brazil) study was carried out and included 50 patients (aged between 9 months and 21 years) diagnosed as having cystic craniopharyngioma treated between 1990 and 2000. Forty-nine children were available for the final analysis. The patients were divided into 3 groups: group I, 24 children who underwent a craniotomy and catheter placement under direct vision using a surgical microscope; group II, 14 children who were submitted to a stereotactic approach for the placement of the intratumoral catheter; and group III, 11 children whose catheters were placed by a freehand approach through a burr hole. Results Eight children (16.3%) presented complications related to the placement of the catheter, namely, misplacement or leakage. The rate of the complications did not appear to be related to one specific modality of the catheter insertion. Conclusion Intracystic antiblastic drug injection is one available option in the treatment of cystic craniopharyngiomas. Because of the toxic effect of these drugs on the brain, determination of the exact placement to avoid leakage is mandatory for correct treatment. However, the results of the present study appear to indicate an excessively high incidence of complications whichever technique is used.