Presentation
Follow-up postoperative case of pathologically proven Adamantinomatous craniopharyngioma developed a progressive headache and visual disturbance as well as endocrinal complications.
Patient Data
There is a predominantly cystic lesion occupying the sella and suprasellar region, with a basal rim of interrupted calcific specks and a small isodense component resembling soft tissue. The lesion is grossly cystic with predominantly hypodense contents. The pituitary gland is not separately identified. The optic chiasm is anteriorly displaced and partially effaced by this lesion. Both lateral ventricles frontal horns are seen compressed by the cystic lesions with mass effect; however, no gross hydrocephalic changes relieved by right posterior parietal VP shunt that is seen traversing right lateral ventricle atrium reaching the midline.
No intraconal/extraconal lesion in either orbit. There is no extension of this mass into the third ventricle.
There are changes related to the right frontotemporal craniotomy bone flap with a shunt tube is seen extending along the extra-axial space extending to basifrontal recess and supra-sellar cistern.
Case Discussion
Craniopharyngioma frequently presents as a cystic component (about 80% of cases and almost 100% recurrences).
Special therapeutic options are suggested to treat grossly cystic craniopharyngioma to reduce fluid production in the cyst and/ or prevent accumulation and encourage its discharge either to the outside or into the CSF pathways.
The first goal can be obtained by radiotherapy via the external route, and the second goal is drainage of the cyst contents.
In our case, the indwelling Ommaya reservoir system (ORS) was adopted as a palliative treatment for draining a recurrent cystic suprasellar tumor.
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