gms | German Medical Science

Objective: Craniopharyngioma is a benign epithelial tumor (WHO grade I), which arises from remnants of Rathke's pouch and grows in the sellar and suprasellar region. Metastasis of craniopharyngioma is rare, and if observed, it may occur along the tract of the surgical approach. We report the occurrence of drop metastasis of craniopharyngioma in the cerebellopontine angle.

Method: A 25-year-old man underwent resection of a craniopharyngioma via a right pterional craniotomy 6 months earlier. Further history, physical examination and laboratory tests were uneventful. During follow-up, craniocerebral MRI showed a round homogeneous contrast-enhancing tumor in the right cerebellopontine angle with neither relation to the internal auditory canal nor to the dura mater.

Results: Microsurgical resection of the tumor was performed via a lateral suboccipital craniotomy. Intraoperatively, the tumor was yellow-reddish with a cauliflower-like appearance. Histopathological examination revealed an adamantinomatous craniopharyngioma with infiltration of the choroid plexus. The postoperative course was uneventful. Two years postoperatively, the patient was well with no complaints. Craniocerebral MRI showed neither evidence of recurrent tumor in the sellar region nor in the cerebellopontine angle.

Conclusions: Although rare, craniopharyngioma may have the potential for cerebrospinal fluid (CSF) dissemination, possibly during surgical resection. Drop metastasis in the cerebellopontine angle is considered unusual. In order to prevent seeding, measures to avoid spread of tumor cells during surgery need to be installed.