Ventricular Craniopharyngiomas Research Articles

Isolated fourth ventricle craniopharyngioma: Representative case illustration and review of literature

Background: Sella and suprasellar areas are frequently affected by craniopharyngiomas. In this article, eight occurrences have been documented. One is new, and the remaining seven are from previously published articles. Their prevalence in the posterior fossa without expansion from the suprasellar area is unusual. Case Description: We present a case of a primary 4th ventricular craniopharyngioma of the posterior fossa in a 16-year-old male with no association with Gardner’s syndrome. He presented with sudden deterioration of consciousness level and was diagnosed as having a homogeneously contrast enhancing lesion occupying the 4th ventricle with obstructive hydrocephalus. The patient underwent emergency placement of external ventricular drain followed by complete removal of the tumor on the next day by midline suboccipital craniotomy with telovelar approach. Histopathological features were consistent with the adamantinomatous variety of craniopharyngioma. He had complete neurological recovery and no evidence of tumor recurrence in 1-year follow-up. Conclusion: The craniopharyngioma in our case was distinct because it was a solid tumor with no cystic component, exhibited homogeneous contrast enhancement in neuroimaging, developed in the fourth ventricle, and reached the level of foramen magnum, features that had rarely been documented previously. We also reviewed the literature on reported cases of 4th ventricular craniopharyngioma to strengthen knowledge in this area and highlight the embryological basis of ectopic craniopharyngioma.

Feasibility of endoscopic endonasal resection of intrinsic third ventricular craniopharyngioma in adults.

Intrinsic third ventricular craniopharyngiomas (IVCs) are usually considered as a contraindication of endoscopic endonasal approach (EEA). The aim of this study is to evaluate the safety and feasibility of EEA for the resection of IVCs based on MRI topographical diagnosis and surgical findings. We reviewed the data of 22 patients who were diagnosed to be IVCs according to five MRI criteria and underwent surgery through EEA. Sixteen IVCs were resected using endoscopic endonasal infrachiasmatic corridor, five IVCs by using endoscopic endonasal suprachiasmatic trans-lamina terminalis corridor, and one IVC by using both the infrachiasmatic and suprachiasmatic corridors. During the operation, all the 22 cases were verified to be IVCs. Gross total resection was achieved in 21 (95.5%) patients. After surgery, visual improvement was observed in 14 (63.6%) patients, no change in 6 (27.3%) patients, and some deterioration in 2 (9.1%) patients. An improvement in intellectual ability was observed in nine (40.9%) patients, no change in twelve (54.5%) patients, and some deterioration in one (4.5%) patient. Fifteen of the 22 patients (68.2%) developed new endocrinological deficit. One postoperative cerebral spinal fluid leakage occurred. EEA can be used as a safe and efficacious approach for the radical resection of IVCs. The combination of the five MRI criteria may serve as an accurate preoperative diagnostic tool to define the topographical relationships between craniopharyngiomas and the third ventricle. The endoscopic transnasal view from below has the advantage of clarifying the relationship between tumors and the third ventricle floor.

Commentary: Endoscopic Transcortical-Transventricular Approach in Treating Third Ventricular Craniopharyngiomas-Case Series With Technical Note and Literature Review.

Commentary: Endoscopic Transcortical-Transventricular Approach in Treating Third Ventricular Craniopharyngiomas-Case Series With Technical Note and Literature Review.

Endoscopic Transcortical-Transventricular Approach in Treating Third Ventricular Craniopharyngiomas-Case Series With Technical Note and Literature Review.

A paradigm shift toward less radicality in the treatment of craniopharyngioma (CP) has increasingly gained recognition. In selected patients, a less invasive approach aiming at cyst decompression may be suitable. To present our experience with the endoscopic transcortical-transventricular approach (ETTA) for the treatment of CP located in the third ventricle, describe our surgical technique, and explore the results reported in the literature. Data for third ventricular CPs treated using ETTA in 2 tertiary medical centers between 2006 and 2020 were retrospectively reviewed. Cystic, mixed lesion, new, and recurrent cases were included. ETTA aimed at cyst fenestration, subtotal or partial tumor resection, managing the hydrocephalus, or a combination of these modalities. Fractionated radiotherapy (RT) was performed (54 Gy in 30 fractions). The described approach was performed in 13 patients with a mean age of 30.2 years. Tumor excision was attempted in 10 patients. Cystic fenestration alone was conducted in 3 patients, followed by intracystic catheter implantation in 2 patients. Permanent diabetes insipidus developed in 3 patients, and 1 patient experienced a surgical site infection. The recurrence rate for ETTA + RT (pre-ETTA in 33.3%) was 2/9 (22.2%) after a mean follow-up of 21.3 months. Four patients did not undergo RT after ETTA, and all these patients experienced recurrences after a mean follow-up of 15.5 months. Hydrocephalus resolved in all 6 patients who presented with accompanying hydrocephalus. ETTA combined with adjuvant RT is a safe and effective option in the management of cystic or predominantly cystic CP extending into the third ventricle. This procedure also effectively treats the accompanying hydrocephalus.

Endoscopic transcortical-transventricular approach in treating third ventricular craniopharyngiomas: technical note and literature review

Endoscopic transcortical-transventricular approach in treating third ventricular craniopharyngiomas: technical note and literature review

Xanthogranulomatous colloid cyst: Radiologic– pathologic correlation and diagnostic difficulties

Background:Despite colloid cyst in the third ventricle is a very usual cause of hydrocephalus, its xanthogranulomatous variant is rare. The most important differential diagnosis is the third ventricular craniopharyngioma. To the best of the authors’ knowledge, there have been few cases of xanthogranulomatous variant colloid cysts reported in the English literature.Case Description:A 77-year-old white woman presented with headaches, memory loss, and abnormal gait for the past 4 months. Magnetic resonance imaging revealed a solid cystic lesion measuring 3.0 cm×2.8 cm×2.9 cm located inside the anterior portion of the third ventricle causing obstructive hydrocephalus. The posterior portion of the lesion was predominantly solid and hypointense on T2 and T1, with areas of post- contrast enhancement, and the anterior portion was predominantly cystic with both hyper- and hypointense areas on T1 and T2, with no suppression on fluid-attenuated inversion recovery and no restriction to diffusion. The patient underwent a left frontal craniotomy with pterional approach, and the lesion was removed microsurgically.Conclusion:Xanthogranulomatous reaction is rarely described in colloid cysts, which happens as a response to desquamation of epithelial lining, subsequent lipid accumulation, and as tissue inflammatory response to intracystic hemorrhage. Microsurgical resection is the treatment of choice. As compared to the plain colloid cyst, these lesions are difficult to fully excise as the inflammatory reaction to the xanthomatous material leads to adhesions to adjacent structures; therefore, the aspiration of cystic contents without spillage is advisable to achieve maximal resection of cyst walls.

Trans-eyebrow supraorbital keyhole approach in suprasellar and third ventricular craniopharyngioma surgery: the experience of 27 cases and a literature review.

The trans-eyebrow supraorbital keyhole approach, a minimal transcranial approach, has been widely used in different types of surgery for sellar and parasellar lesions. In this study, we investigated the outcome of this approach in the surgical treatment of suprasellar and third ventricular craniopharyngioma. Twenty-seven patients with suprasellar and third ventricular craniopharyngioma underwent surgery via a supraorbital approach between June 2007 and June 2018. The medical data and follow-up results were retrospectively analyzed. All tumors were located in the suprasellar region and the third ventricle. The mean tumor size was 29.1mm. The mean follow-up period was 49.6months. Gross total resection (GTR) was achieved in 23 patients (85.2%). Of 17 patients with preoperative visual impairment, 12 patients (70.6%) showed improvement. Following surgery, 11 patients exhibited new-onset anterior hypopituitarism, ten developed diabetes insipidus, and two became overweight. One residual tumor relapsed 1year after surgery. No perioperative death, cerebrospinal fluid (CSF) rhinorrhea, or meningitis occurred. All patients exhibited satisfactory cosmetic results. At the last follow-up, the Extended Glasgow Outcome Scale Score was 8 in 25 patients (92.6%). The supraorbital trans-eyebrow keyhole approach is characterized by minimal invasion and a satisfactory cosmetic outcome. According to our experience, craniopharyngiomas located in the suprasellar region and the third ventricle can be safely resected via a trans-eyebrow supraorbital keyhole approach.

Endonasal endoscopic transsphenoidal resection of intrinsic third ventricular craniopharyngioma: surgical results.

Intrinsic third ventricular craniopharyngiomas (IVCs) have been reported by some authors to "pose the greatest surgical challenge" of all craniopharyngiomas (CPAs). A variety of open microsurgical approaches have historically been used for resection of these tumors. Despite increased utilization of the endoscopic endonasal approach (EEA) for resection of CPAs in recent years, many authors continue to recommend against use of the EEA for resection of IVCs. In this paper, the authors present the largest series to date utilizing the EEA to remove IVCs. The authors reviewed a prospectively acquired database of the EEA for resection of IVCs over 14 years at Weill Cornell Medical College, NewYork-Presbyterian Hospital. Preoperative MR images were examined independently by two neurosurgeons and a neuroradiologist to identify IVCs. Pre- and postoperative endocrinological, ophthalmological, radiographic, and other morbidities were determined from retrospective chart review and volumetric radiographic analysis. Between January 2006 and August 2017, 10 patients (4 men, 6 women) ranging in age from 26 to 67 years old, underwent resection of an IVC utilizing the EEA. Preoperative endocrinopathy was present in 70% and visual deterioration in 60%. Gross-total resection (GTR) was achieved in 9 (90%) of 10 patients, with achievement of near-total (98%) resection in the remaining patient. Pathology was papillary in 30%. Closure incorporated a "gasket-seal" technique with nasoseptal flap coverage and either lumbar drainage (9 patients) or a ventricular drain (1 patient). Postoperatively, complete anterior and posterior pituitary insufficiency was present in 90% and 70% of patients, respectively. In 4 patients with normal vision prior to surgery, 3 had stable vision following tumor resection. One patient noted a new, incongruous, left inferior homonymous quadrantanopsia postoperatively. In the 6 patients who presented with compromised vision, 2 reported stable vision following surgery. Each of the remaining 4 patients noted significant improvement in vision after tumor resection, with complete restoration of normal vision in 1 patient. Aside from the single case (10%) of visual deterioration referenced above, there were no instances of postoperative neurological decline. Postoperative CSF leakage occurred in 1 morbidly obese patient who required reoperation for revision of closure. After a mean follow-up of 46.8 months (range 4-131 months), tumor recurrence was observed in 2 patients (20%), one of whom was treated with radiation and the other with chemotherapy. Both of these patients had previously undergone GTR of the IVC. The 10 patients described in this report represent the largest number of patients with IVC treated using EEA for resection to date. EEA for resection of IVC is a safe and efficacious operative strategy that should be considered a surgical option in the treatment of this challenging subset of tumors.

A Proposed Algorithm for the Management of Large Third Ventricular Craniopharyngiomas

A Proposed Algorithm for the Management of Large Third Ventricular Craniopharyngiomas

Suprachiasmatic translamina terminalis corridor used in endoscopic endonasal approach for resecting third ventricular craniopharyngioma

The translamina terminalis corridor was used in the transcranial anterior route to treat third ventricular craniopharyngioma (TVC), which presents a challenge to neurosurgeons. The endoscopic endonasal approach (EEA) has recently been used to treat craniopharyngiomas. However, there are few reports of the EEA being used to treat TVC. The authors' novel surgical approach of treating selected TVC by the endoscopic endonasal route via the suprachiasmatic translamina terminalis (STLT) corridor is described. In this single-center study, the EEA via the STLT corridor was used to resect TVC with great upper and anterior extension causing bulged lamina terminalis, and TVC with a residual upper compartment, after routine infrachiasmatic transmetastalk corridor resection. The STLT corridor was used in 3 patients. Gross-total resection was achieved in all cases. One patient achieved visual improvement, and the other 2 patients showed partial visual improvement. Leakage of CSF occurred in 1 patient. Postoperative hormone replacement therapy was required in all patients. The STLT corridor is a complementary minimally invasive corridor used in the EEA for treating selected TVC. The STLT alone or combined with infrachiasmatic transmetastalk corridors should be selected depending on the size of suprachiasmatic and infrachiasmatic space.

Third ventricular cavernoma: Report of two cases.

Sir/Madam, Cerebral parenchyma is the most common site for a cavernoma in the nervous system. Intraventricular cavernomas are rare and constitute 2.5-10.8% of cerebral cavernomas.[1] Third ventricular cavernomas are even rare, only 25 cases have been reported in the literature.[2] We report two more cases of third ventricular cavernomas. The first patient was a 54-year-old man, who presented with acute headache and vomiting. He was unconscious on arrival in casualty. CT scan showed third ventricular hemorrhage [Figure 1a]. He underwent external ventricular drainage, followed by ventriculo-peritoneal (VP) shunt later. An MRI done at 10 days after ictus showed a mixed density lesion with hemorrhagic component occupying the third ventricle with broad base on the floor [Figure 1b]. He underwent tranacallosal-interhemispheric approach and total excision of the lesion. The tumor was arising from the floor of the third ventricle. Histopathology was cavernoma. After surgery the patient developed diabetes insipidus, which was managed with desmopressin. Figure 1 (a) CT scan showing hemorrhage in third ventricle. (b) MRI showing a heterogeneous lesion in the third ventricle with bleed The second patient was a 6-year-old girl who presented with headache and vomiting for 2 months. CT scan showed a calcified in third ventricle with hydrocephalus [Figure 2a]. MRI showed a heterogeneous lesion occupying the entire third ventricle [Figure 2b]. There was no evidence of recent hemorrhage. She underwent VP shunt followed by subfrontal approach, and only partial excision of the lesion as the lesion was densely adherent to the floor of the third ventricle. Histopathology was cavernoma. After surgery she developed transient hyponatremia, which was managed medically. Figure 2 (a) CT scan showing calcified tumor in third ventricle. (b) MRI showing a heterogeneous lesion in the third ventricle Third ventricular cavernomas can present with signs and symptoms of any third ventricular tumors, however they usually present with symptoms of hydrocephalus.[2] Presentation as intraventriuclar hemorrhage is uncommon, and only three cases have been reported.[2] Our first patient presented with hemorrhage, and second with hydrocephalus. They can arise from the suprachiasmatic region, foramen of Monroe, lateral wall or floor of third ventricle.[3] Both of our patients had cavernomas arising from floor of third ventricle. The imaging appearance is that of typical cavernomas. The close differential diagnosis in the absence of hemorrhage is third ventricular craniopharyngioma. The natural history of intraventricular cavernoma is not known. There is a risk of hemorrhage and acute hydrocephalus if the lesion is not excised completely. However, there is risk of hypothalamic damage in case of complete resection of lesion arising from floor of third ventricle, as it happened in our first case. It may be worthwhile doing only a VP shunt for hydrocephalus if the lesion is arising from the floor of the third ventricle.[4]

Xanthogranulomatous colloid cyst of the third ventricle

Colloid cyst in the third ventricle is a common entity, whereas a variant of it, namely xanthogranulomatous, is quite rare. The closest imaging differential diagnosis is a purely third ventricular craniopharyngioma. We herein describe a case of xanthogranulomatous colloid cyst presenting with hydrocephalus.

Modified one-piece extended transbasal approach for translamina terminalis resection of retrochiasmatic third ventricular craniopharyngioma

Retrochiasmatic third ventricular craniopharyngiomas are formidable tumors to remove surgically. Access to the third ventricle can be achieved through the lamina terminalis corridor. A skull base approach to the lamina terminalis can be performed using either an anterolateral approach (orbitozygomatic, pterional, supraorbital) or a midline approach (extended transbasal, subfrontal). The major disadvantage of an anterolateral approach is the lack of visualization of the ipsilateral wall of the third ventricle and hypothalamus. However, a midline transbasal approach eliminates this blind spot thereby providing direct visualization of both ependymal walls for safe dissection of the tumor. In this operative video manuscript, the author demonstrates an illustrative step-by-step technique for translamina terminalis resection of a retrochiasmatic retroinfundibular craniopharyngioma within the third ventricle via a modified one-piece extended transbasal approach. This approach uses the standard bifrontal craniotomy and incorporates the anterior wall of the frontal sinus as a one-piece flap. The inferior limit of the osteotomy is based along the coronal contour of the anterior skull base which eliminates any bony overhang that can obstruct the line of sight to the lamina terminalis. Additional removal of the supraorbital bar is not necessary. The operative technique for this skull base approach and surgical nuances for craniopharyngioma resection are illustrated in this video atlas. The video can be found here: http://youtu.be/E3Bsp6dUdAE. (http://thejns.org/doi/abs/10.3171/2013.V1.FOCUS12354)

Microsurgical treatment of purely intrinsic third ventricula craniopharyngioma

Objective To study the clinical characteristics,microsurgical methods and results of treatment of the purely intrinsic third ventricular craniopharyngioma. Methods Eight cases of craniopharyngiomas located purely in intrinsic third ventricula which were treated microsurgically were analyzed retrospectively.Their clinical manifestations,endocrinal examination,CT and MRI images,choice of operactive approaches and post-operative complications were studied.Results Total tumor removals were achieved in 7 cases.and subtatol tumor removal in 1 case.Temporary central diabetes insipidus occurred in 5 cases,and perloperative water and elecctrolyte imbalance in 6 cases. No patient died in this series. Conclusion According to clinical characteristic of purely intrinsic third ventricular craniopharyngioma, microsurgical technique is a safe and effective method for treatment by a resonable surgical approaches. Key words: Craniopharyngioma; Third ventricle; Microsurgical operation

Venous Air Embolism during Neuroendoscopy

Sir, Among the various problems associated with neuroendoscopic surgery, venous air embolism (VAE) has not been described earlier. We report here the development of this complication during endoscopic removal of a third ventricular (TV) craniopharyngioma cyst in an adult male patient and hypothesise the probable causative mechanism. This patient was subjected to our routine anaesthesia & monitoring protocol and neuroendoscopic technique. Before the start of surgery, the patient's heart rate (HR) was 86 beats/min, invasive arterial blood pressure (ABP) was 114/72 mmHg, end-tidal carbon dioxide value (EtCO 2) was 33 mmHg and pulse oximetry value (SpO 2) was 99%. Excision of the TV cyst was begun with a rigid neuroendoscope aided by a slow infusion of the irrigating fluid. During surgery, profuse bleeding occurred from a torn septal vein, obscuring the surgical field. The rate of irrigation was stepped up, the egress port of the endoscope was occluded to tamponade the bleeding and cauterization was attempted. Suddenly, the patient's HR and ABP increased to 154 beats/min & 177/94 mmHg respectively, followed immediately by an abrupt fall in his EtCO

Comparison of hypothalamopituitary axis dysfunction of intrasellar and third ventricular craniopharyngiomas in children

In this study, we attempted to determine if different locations of a tumor influence the hypothalamopituitary axis function and outcomes with childhood craniopharyngiomas. The preoperative, postoperative, and long-term follow-up endocrinological disturbances of 66 children with a craniopharyngioma were retrospectively studied. The patients were divided into two subgroups according to the location of the tumor (intrasellar and third ventricle floor). The mean age at onset was 8.02 (range, 1.42–17.58) years. These patients were followed-up for a median duration of 7.2 (range, 2–22) years. Vision problems as the first symptom were more common in Group One (with intrasellar tumors) compared to Group Two (55.6% vs 15.4%; p = 0.001; Fisher’s exact test). Increased intracranial pressure was the most common initial symptom in patients in Group Two (51.3%) and the second most common symptom in Group One (37%). The majority of patients in both Group One and Group Two required some forms of pituitary hormone supplements (96% vs 84%). At the last follow-up, more patients with intrasellar craniopharyngiomas needed cortisone supplements (79.2% in Group One vs 45.9% in Group Two; p = 0.016; Fisher’s exact test); however, children with third ventricle floor tumors had more prevalent weight gain (4.2% in Group One vs 27.0% in Group Two; p = 0.038; Fisher’s exact test). There were different initial presentations and endocrinological outcomes between children with intrasellar and third ventricle floor craniopharyngiomas. The intrasellar tumors had greater pituitary hormone disturbance. However, at the long-term follow-up, children with third ventricle floor tumors had a greater prevalence of being overweight and obese, which was associated with hypothalamic dysfunction.

Intra-third ventricular craniopharyngiomas: imaging characteristics, histopathology and successful trans-lamina terminalis approach

Craniopharyngiomas usually grow from remnants of Rathkes' pouch and frequently locate on the cisternal surface of the hypothalamic region. However, this tumor can grow exclusively within the third ventricle. During the past 18 years, five purely intra-third ventricular craniopharyngiomas were experienced in our institute. Four patients were male and the patient ages ranged from 13 to 52 years. Presenting clinical symptoms and signs included visual impairments in three, mental deterioration in two, headache and pituitary insufficiency in two. The histopathology was papillary and squamous in three and adamontimomatous in two. Precise tumor location and morphology were established with CT and MRI. The mass was solid and well enhanced in two patients, mainly solid with small rim enhancing cysts in two and multi-cystic with calcification in one. Hypothalamic brain edema was observed in a huge tumor of a papillary type. Spotty or massive calcification was noted in each of the two tumors of an adamantinomatous type. Although there are several surgical approaches available to resect an intra-third ventricular tumor, all our cases were operated through an interhemispheric trans-lamina terminalis approach. Gross total resection was performed in all cases at the initial surgery. Microsurgical findings revealed: (1) little or no tumor adhesion to the ventricular walls and the roof, (2) firm attachment to the floor of the ventricle around the vicinity of the tuber cinereum. The origin seemed to be the floor, (3) another important finding was small feeders coming from the anterior part of the circle of Willis. In order to get a direct view of the most delicate part of the tumor dissection, the trans-lamina terminalis approach was a valid choice. Recurrence was noted 8 months later in one patient followed by a total resection using the same route. No radiotherapy was applied in all patients. In the post-operative period, precise assessment of body fluid and hormone is mandatory and accurate replacement treatments are needed even months or years. All patients returned to their previous activity.

Intrinsic third ventricular craniopharyngiomas: report on six cases and a review of the literature

Background Craniopharyngiomas constitute 2 to 4% of intracranial neoplasms. However, the purely intraventricular variety are rare. Their magnetic resonance imaging (MRI) characteristically shows an intact third ventricular floor, a patent suprasellar cistern, an intact pituitary stalk, and the absence of sellar abnormalities. Methods Between 1994 and June 2002, 6 patients with purely intraventricular craniopharyngioma were surgically managed. There were 4 cystic and 2 solid lesions. The surgical approaches utilized included a frontal, parasagittal, transcallosal approach with the third ventricle being accessed using either the transforaminal or subchoroidal approach ( n = 3); pterional, transsylvian ( n = 1), and bifrontal interhemispheric ( n = 2) approaches in which the third ventricle was accessed via the lamina terminalis. A ventriculoperitoneal shunt was required for one of the 3 patients with hydrocephalus. Results Total excision was performed in 3 patients with cystic craniopharyngioma, while a small residual lesion was left adherent to the third ventricular floor in the others. There was one perioperative mortality because of septicemia. Two patients required thyroxine supplementation. Two patients developed transient and one other patient a sustained diabetes insipidus. The 2 patients with solid tumors received radiotherapy for the residual lesions. At follow up ranging from 8 to 36 months, neither tumor recurrence nor regrowth was observed in any of the patients. The symptoms of raised intracranial pressure, hypothalamic dysfunction or visual field defects had resolved. Conclusions Intraventricular craniopharyngiomas occur in an older population and present mainly with raised intracranial pressure. Visual and endocrinologic imbalances are much less in these lesions compared to the suprasellar craniopharyngiomas. They mainly attach to the third ventricular floor. The surgical approaches to the third ventricle, along with radiotherapy and hormone supplementation, were successful in the management of these rare tumors.

The neurological abnormalities and operative findingsin the transcallosal approach for large juxtasellar–ventricular craniopharyngiomas

From February 1994 to June 1999, there were 36 patients who underwent microsurgical resection for craniopharyngiomas. Of6 adult patients, large tumours (>4cm) with extension from intrasellar or parasellar space to the foramen of Monro were found. There were 4 male and 2 female patients with ages from 18 to 44 years (mean 32.4 years). All of them underwent one-stage interhemispheric transcallosal total exc ision of tumours. This approach affords good overhead view of tumours and surrounding structures.Preoperatively, decreased visual acuity and restriction in the visual field was found in 5 patients. Studies of anterior pituitary function revealed far below the normal range in all patients. Polyuria was noted in 4 patients. All of 6 patients showed abnormally high levels of blood cholesterol and triglyceride and 4 patients were obese. Tumours with extension into the pituitary fossa were found in 2 cases. A relatively caudal location in the third Ventricle was found in case 6, who showed better preoperative visual function and no polyuria. There were no major surgical complications encountered. One patient with high cholesterol (731mg%) died of acute pancreatitis 6 months after surgery.For large craniopharyngiomas without pre-chiasmatic extension, proper treatment could be achieved under substitution therapy and one stage transcallosal total excision of tumours with preservation of important neural structures.

Craniopharyngioma intrinsic to the third ventricle

The case of a third ventricular craniopharyngioma in a 57-year-old woman is reported. This lesion is rare, having been previously identified in only eight adults. Intraventricular craniopharyngioma is also unusual in that it is not associated with tumoral calcification or cyst formation, as is frequently seen with the more common suprasellar craniopharyngioma. The role of computed tomography scanning in the diagnosis of this tumor is presented and discussed.