gms | German Medical Science

Objective: Craniopharyngeomas as benign extra-axial tumors frequently containing cystic formations are typically located in the sellar region. They mostly cause symptoms like visual impairment, visual field defects and endocrine disorders. Due to high potential morbidity associated with radical resection, several less invasive surgical methods followed by radiotherapy have been developed. We investigated stereotactic implantation of cysto-ventricular catheters as new method to control cystic components.

Methods: We analyzed clinical data of all patients with craniopharyngeomas treated primarily with stereotactic cysto-ventricular shunting in our hospital between 04/2013 and 05/2015. Special focus was safety of this technique as well as improvement of symptoms and reduction of cyst volumes compared pre- to postoperatively and at follow-up examinations.

Results: Eight patients received cysto-ventricular catheters in order to control cyst size (5 male, 3 female, mean age 69,5 years). Mean duration of surgery was 47,5 minutes. Three patients underwent operative revision to correct catheter position. Except one parenchymatous bleeding without acute or chronic neurological deterioration, no further complications (bleeding, infection, epilepsy or new neurological problems) occurred. Visual impairment improved in 7 of 8 affected patients; visual field defects improved in 6 of 7 affected patients. Endocrine disorders remained stable without deterioration. All patients were treated with radiotherapy (1 prior to, 7 after surgery). Volumetric analysis demonstrated a mean reduction of cyst volume of 90,1 % postoperatively and further of 93,6 % at follow-up (mean follow-up 19,1 (9-37) months) compared to preoperative values. Total tumor volumes (including solid tumor and cysts) were reduced by 82,7 % at follow up after completed radiotherapy.

Conclusion: Based on our data stereotactic implantation of cysto-ventricular catheters in patients with craniopharyngeomas seems to be a minimally invasive method to improve ophthalmological symptoms, to control cystic components and thus to reduce total tumor volume. This leads to improved conditions for radiotherapy. Given the low surgical morbidity as well as the effective drainage of tumor cysts, this method combined with radiotherapy should be considered in the treatment of selected craniopharyngeomas.