Gross total excision of pediatric giant cystic craniopharyngioma with huge retroclival extension to the level of foramen magnum by anterior trans petrous approach: report of two cases and review of literature

Abstract

Craniopharyngiomas with a large posterior fossa extension beyond the level of the foramen magnum are very rare and usually removed in two stages. The objective of this paper is to report that such rare cases of giant cystic predominantly retrochiasmatic retroclival craniopharyngiomas can be completely excised by an anterior transpetrous approach in a single stage. The first case was a 6-year-old boy who presented with a 1-year history of recurrent episodes of seizures, headache, and vomiting. The second case was a 10-year-old girl who presented with history of headache, visual deterioration, and left-side hemiparesis for one and half years. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) in both these patients revealed a giant sellar suprasellar cystic lesion with areas of calcification and the lesion was predominantly retrochiasmatic with a huge retroclival posterior fossa extension down to the level of the C1 vertebra and laterally to the cerebellopontine angle. Gross total excision of both suprasellar and posterior fossa extensions could be done in both the patients through an anterior transpetrous transtentorial approach (Kawase's approach). Postoperative imaging (MRI/CT) revealed no obvious evidence of residual tumor. The first patient had right hemiparesis from which he recovered completely. The second patient died suddenly on postoperative day 4 after initial uneventful postoperative period, and the exact cause of death is not known. Giant cystic craniopharyngiomas, which are predominantly retrochiasmatic and associated with huge retroclival posterior fossa extensions, can be removed in single stage by Kawase's approach.