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CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2018; 79(S 03): S256-S258
DOI: 10.1055/s-0038-1636504
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Transsphenoidal Salvage Surgery for Symptomatic Residual Cystic Craniopharyngioma after Radiotherapy

Enzo Emanuelli
1   Department of Neurosciences, Otorhinolaryngology Section, University of Padua, Padua, Italy
,
Giuliana Frasson
1   Department of Neurosciences, Otorhinolaryngology Section, University of Padua, Padua, Italy
,
Diego Cazzador
1   Department of Neurosciences, Otorhinolaryngology Section, University of Padua, Padua, Italy
,
Daniele Borsetto
1   Department of Neurosciences, Otorhinolaryngology Section, University of Padua, Padua, Italy
,
Luca Denaro
2   Department of Neurosciences, Neurosurgery Section, University of Padua, Padua, Italy
› Author Affiliations
Further Information

Publication History

15 October 2017

12 December 2017

Publication Date:
08 February 2018 (online)

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Abstract

Objectives Ideal treatment of craniopharyngiomas is still controversial. Radiotherapy (RT) is considered effective for recurrences or after subtotal tumor removal (STR). About 40 to 50% of patients may experience tumor cyst expansion soon after RT; in these cases, the role of salvage surgery is debated.

Design Operative video.

Setting Tertiary care center.

Participants An 11-year-old boy diagnosed with persistent craniopharyngioma. In 2015, the patient underwent right frontotemporal craniotomy for STR at another center, complicated by panhypopituitarism. Two years later, fractionated 54-Gy RT was performed on growing residual tumor. After 3 months, he was admitted to our hospital due to persistent malaise, vomiting, pulsating headache, and epistaxis. Ophthalmologic evaluation evidenced left homonymous hemianopsia.

Results A contrast-enhanced magnetic resonance imaging (MRI) showed a 27-mm cystic component enlarging from the cranial end of the persistent craniopharyngioma lesion, extending into the third ventricle. Biventricular hydrocephalus and brain midline shift to the right were present. Compared with the early post-RT MRI, the cystic component of the tumor demonstrated growth. The patient underwent external ventricular drainage placement for emergent treatment of hydrocephalus and endoscopic transsphenoidal surgery. After cystic content drainage, the lesion was completely removed with its capsule. A “gasket seal” technique was performed for skull base reconstruction, with autologous fascia lata, septal bone, and mucoperiosteum from inferior turbinate. Histologic examination confirmed the craniopharyngioma diagnosis. Postoperative MRI showed resolution of the hydrocephalus and complete tumor removal.

Conclusion Although shrinkage of cystic components of craniopharyngioma residuals may occur within 5 to 6 months after RT, salvage surgery is indicated in symptomatic patients.

The link to the video can be found at https://youtu.be/4x6Qe76bf60.

Keywords

cystic craniopharyngioma - childhood brain tumor - endoscopic transsphenoidal surgery - anterior skull base