Article
Neuroendoscopic trans-ventricular treatment of cystic craniopharyngioma
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Authors
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A. Delitala
- Neurochirurgia, Ospedale San Camillo, Roma, Italy
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A. Brunori
- Neurochirurgia, Ospedale San Camillo, Roma, Italy
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A. Menniti
- Neurochirurgia, Ospedale San Camillo, Roma, Italy
| Published: | May 30, 2008 |
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Outline
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Objective: Microsurgery is the gold standard in the treatment of craniopharyngiomas. The intimate relationship to the delicate neurovascular structures makes total removal difficult, and there are often endocrinological and neuropsychological sequelae. Moreover, the recurrences have a high mortality rate. Stereotactic aspiration, transsphenoidal fenestration, or intracavitary filling with bleomycin can be performed in the cystic or predominantly cystic lesions as alternative procedures. In the last decade, neuroendoscopy became useful as a sole procedure or as one step of a multimodal protocol. The endoscopic approach can be used for cysts impinging on or growing into the ventricular system (Yasargil C to F types). Depending on the purpose, endoscopy can be implemented for procedures ranging from gross total removal to palliation for control of hydrocephalus prior to microsurgery.
Methods: The cysto-ventriculo-cysternostomy technique is presented; it was proven safe and effective in the long-term treatment of tumors and is an easily repeatable technique. This series reports on 6 patients suffering from predominantely cystic craniopharingiomas, with age ranging from 9 to 75 years. The clinical picture included endocrinological, visual or both signs and symptoms; in one case hydrocephalus was present. A 4 mm. flexible/steerable endoscope was used to obtain a wide communication between the cyst and the subarachnoidal spaces. Through a fenestration of the cystic craniopharyngioma, a complete aspiration of the fluid was performed and subsequently the operative field was rinsed with a Ringer solution until the fluid was clear. A further fenestration of the cyst is then obtained to penetrate downward into the prepontine cistern. To ensure a continuous and complete washing of the cyst by CSF, a multiperforated catheter (stent) was left.
Results: In the follow-up period (6-96 months) 2 recurrences were observed; both patients underwent successful repeated neuroendoscopy. Another patient underwent microsurgical removal of an enlarging solid nodule 9 months after endoscopy. No aseptic meningitis has been reported.
Conclusions: Although oncologically palliative, this technique can be implemented with other therapeutic modalities.
