Minimal Invasive Treatment of Cystic Craniopharyngiomas

Abstract

The management of craniopharyngiomas have been controversial for years. More conservative approaches in the management of craniopharyngioma are reasonable alternatives for treatment. Similar rates of disease control are observed with less morbidity and better quality of survival. We present a case report of a 36 year old male who underwent stereotactic placement of an ommaya catheter with repeated aspiration of cystic portion followed by radiation for a recurrent craniopharyngioma. He has been under followup for 68 months with no reccurance. A 36 year old male who presented with headache, decreased vison and excessive tiredness of one month duration. On examination he had bitemporal hemianopia, vison- R(6/6), L(6/9). There was no motor deficit. He was hypothyroid and had decreased serum testosterone level. MRI brain done revealed a sellar / suprasellar lesion with solid and cystic components measuring 5.6 × 4cm compressing the chiasm. The patient underwent a left pterional craniotomy and decompression of the largely cystic tumor. Small parts of the capsaule adherent to the chiasm were left behind. He was followed up. He developed recurrence of symptoms after 4 months of surgery and MRI showed a recurrence of craniopharyngioma cyst. He underwent stereotactic placement of fine catheter into the cyst connected to an ommaya reservoir from which with repeted aspirations were necessary. Post operatively he recieved stereotactic radiotherapy with X-Knife. He has been on regular followup since then with no recurrence at 68 months. Minimal invasive treatment of the craniopharyngioma cyst wall may be a better alternative than attempting total removal which is associated with a high morbidity. More conservative approaches in the management of largely cystic craniopharyngiomas are reasonable alternatives for treatment. Similar rates of disease control are observed with less morbidity and better quality of survival.