Endoscopic, Image-Guided, Transnasal Instillation of32P for Recurrent Infrachiasmatic Cystic Craniopharyngioma

Abstract

The neurovascular and anatomic relationships surrounding craniopharyngiomas, and their tending to recur despite any method of primary treatment, has characterized this tumor as an exigent and frustrating clinical entity. Various strategies have been developed to deal with recurrences which include radical re-resection, stereotactic or localized radiotherapy, cyst fenestration, marsupialization or stent placement, and intracavitary therapies such as bleomycin or radionucleotides. We present a case where the patient had previously experienced a transsphenoidal resection followed by a pterional, microsurgical resection of her craniopharyngioma at an outside hospital. The second recurrence was cystic, and confined to the sella. We elected to proceed with a minimally invasive, transnasal endoscopic approach for the instillation of phosphorus 32 radionucleotide into the cyst. There were no complications, and the patient was discharged home on postoperative day one. At six months, there was no progression of the cyst. While intracystic adionucleotide therapies have been utilized for primary and secondary treatment of craniopharyngioma, to our knowledge, this is the first report of the delivery of this therapy by an endoscopic transsphenoidal route.