Transcranial endoscopic management of pediatric cystic craniopharyngioma: Preliminary results

Abstract

Craniopharyngiomas (CPs) are histological benign lesions that can develop at different positions along the pituitary–hypothalamic axis from the sella to the third ventricle. A common characteristic of pediatric CPs is the presence of a large suprasellar cystic component and symptoms are mainly caused by direct compression over adjacent neurovascular structures and obstruction of the Cerebrospinal Fluid (CSF) flow pathway. They represent a distinctive management challenge, and aggressive surgical resection can have major postoperative complications and adverse outcomes. The transcranial endoscopic decompression of cysts followed by the placement of an Ommaya reservoir is a safe, minimally invasive technique used to abolish symptoms caused by the pressure effect. In this study, we present our experience of managing cystic CPs of pediatric age using the transcranial endoscopic approach.Six consecutive cystic CP cases operated on using the transfrontal transventricular approach between 2015 and 2018 were retrospectively reviewed. An endoscope was introduced through a Kocher’s burr hole, the cyst fenestrated, and the contents gently aspirated using an angiography catheter and a 5-ml syringe. The cyst wall, free from surrounding structures, was excised, and the remnants coagulated. An Ommaya reservoir was placed in all cases.Headache and hydrocephalus were relieved in all cases (6/6), and visual improvement was observed in 5/6 cases. Post-operative diabetes insipidus and hypothalamic dysfunction were not observed in any patient. One patient with cyst recurrence at follow-up underwent subtotal resection followed by adjuvant radiotherapy.Our experience with limited number of cases demonstrates that the transcranial endoscopic approach is a minimally invasive and safe technique for the decompression of cystic CPs. It provides acceptable long-term disease control and circumvents the complications associated with radical surgery.