Neuroendoscopic Surgery for Acute Presentation of Cystic Craniopharyngiomas

Overview

Journal Neurosurg Rev

Date 2025 Jan 19

PMID 39828797

Authors

Ao Chen

Jianxian Li

Xun Chen

Fei Wang

MingDa Ai

Xiaoyan Yao

Tao Sun

Renhui Zhou

Affiliations

Soon will be listed here.

Abstract

Acute presentation of cystic craniopharyngioma is a potentially life-threatening condition, characterized by disability and increased mortality risk, often caused by large cysts with or without hydrocephalus. This study evaluated the applicability of minimally invasive neuroendoscopic surgery (NES) for rapid intracranial pressure relief and tumor control as an alternative to emergent microsurgical resection. A retrospective review of the electronic medical record database of patients with craniopharyngiomas treated at our institution between June 2007 and October 2024 identified 13 non-consecutive cases of acute presentation of cystic craniopharyngioma managed with NES. Interventions included pellucid septostomy (n = 2), ventriculoperitoneal shunt surgery (n = 2), and Ommaya reservoir placement (n = 6). Clinical and radiological data were analyzed to assess treatment outcomes. The most common acute symptoms were severe headache (69.2%), frequent vomiting (53.8%), sudden onset of consciousness disturbance (38.5%), visual impairment (46.2%), gait instability (23.1%), and cognitive dysfunction (15.4%). Ten patients had hydrocephalus at admission. All patients experienced symptom relief following NES, with no procedure-related mortality or complications. Hydrocephalus resolved in all cases, and subjective visual function improved in 83.3% of patients postoperatively. Endocrine function remained stable. At a median follow-up of 62 months (range, 38-130), local tumor control was achieved in 8 patients (61.5%) without requiring adjuvant therapy. NES is a safe, effective approach for managing acute presentation of cystic craniopharyngioma, particularly in patients with hydrocephalus. It offers rapid symptom relief and tumor control and is a potential staging treatment in selected cases.

References

GOLDBERG G, ESHBAUGH D . Squamous cell nests of the pituitary gland as related to the origin of craniopharyngiomas. A study of their presence in the newborn and infants up to age four. Arch Pathol. 1960; 70:293-9. View

Johnson L, Hepler R, Yee R, Frazee J, Simons K . Magnetic resonance imaging of craniopharyngioma. Am J Ophthalmol. 1986; 102(2):242-4. DOI: 10.1016/0002-9394(86)90152-2. View

Muller H, Merchant T, Warmuth-Metz M, Martinez-Barbera J, Puget S . Craniopharyngioma. Nat Rev Dis Primers. 2019; 5(1):75. DOI: 10.1038/s41572-019-0125-9. View

Nicolato A, Foroni R, Rosta L, Gerosa M, Bricolo A . Multimodality stereotactic approach to the treatment of cystic craniopharyngiomas. Minim Invasive Neurosurg. 2004; 47(1):32-40. DOI: 10.1055/s-2003-812467. View

Rajan B, Ashley S, Thomas D, Marsh H, Britton J, Brada M . Craniopharyngioma: improving outcome by early recognition and treatment of acute complications. Int J Radiat Oncol Biol Phys. 1997; 37(3):517-21. DOI: 10.1016/s0360-3016(96)00537-8. View

Nielsen E, Jorgensen J, Bjerre P, Andersen M, Andersen C, Feldt-Rasmussen U . Acute presentation of craniopharyngioma in children and adults in a Danish national cohort. Pituitary. 2012; 16(4):528-35. DOI: 10.1007/s11102-012-0451-3. View

Muller H . Consequences of craniopharyngioma surgery in children. J Clin Endocrinol Metab. 2011; 96(7):1981-91. DOI: 10.1210/jc.2011-0174. View

Chen A, Ai M, Sun T . Advances in the treatment of Adamantinomatous craniopharyngioma: How to balance tumor control and quality of life in the current environment: a narrative review. Front Oncol. 2024; 13:1326595. PMC: 10771305. DOI: 10.3389/fonc.2023.1326595. View

Hollon T, Savastano L, Altshuler D, Barkan A, Sullivan S . Ventriculoscopic Surgery for Cystic Retrochiasmatic Craniopharyngiomas: Indications, Surgical Technique, and Short-Term Patient Outcomes. Oper Neurosurg (Hagerstown). 2017; 15(2):109-119. DOI: 10.1093/ons/opx220. View

10.

Takano S, Akutsu H, Mizumoto M, Yamamoto T, Tsuboi K, Matsumura A . Neuroendoscopy Followed by Radiotherapy in Cystic Craniopharyngiomas--a Long-Term Follow-Up. World Neurosurg. 2015; 84(5):1305-15.e1-2. DOI: 10.1016/j.wneu.2015.06.022. View

11.

Lauretti L, Sop F, Pallini R, Fernandez E, DAlessandris Q . Neuroendoscopic Treatment of Cystic Craniopharyngiomas: A Case Series with Systematic Review of the Literature. World Neurosurg. 2017; 110:e367-e373. DOI: 10.1016/j.wneu.2017.11.004. View

12.

Nakamizo A, Inamura T, Nishio S, Inoha S, Ishibashi H, Fukui M . Neuroendoscopic treatment of cystic craniopharyngioma in the third ventricle. Minim Invasive Neurosurg. 2001; 44(2):85-7. DOI: 10.1055/s-2001-16003. View

13.

Chen A, Zhou R, Yao X, Ai M, Sun T . Neuroendoscopic treatment of giant cystic craniopharyngioma in the foramen magnum: report of two cases. Childs Nerv Syst. 2020; 37(7):2387-2390. DOI: 10.1007/s00381-020-04965-0. View

14.

Delitala A, Brunori A, Chiappetta F . Purely neuroendoscopic transventricular management of cystic craniopharyngiomas. Childs Nerv Syst. 2004; 20(11-12):858-62. DOI: 10.1007/s00381-004-0943-1. View

15.

Chen A, Zhou R, Yao X, Tong Z, Li J, Xiang R . Neuroendoscopic surgery combined with Ommaya reservoir placement for cystic craniopharyngiomas: 11 years of experience in a single institution. Br J Neurosurg. 2022; 38(6):1312-1318. DOI: 10.1080/02688697.2022.2152776. View

16.

SYNEK V, REUBEN J, DU BOULAY G . Comparing Evans' index and computerized axial tomography in assessing relationship of ventricular size to brain size. Neurology. 1976; 26(3):231-3. DOI: 10.1212/wnl.26.3.231. View

17.

YASARGIL M, Curcic M, Kis M, Siegenthaler G, Teddy P, Roth P . Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients. J Neurosurg. 1990; 73(1):3-11. DOI: 10.3171/jns.1990.73.1.0003. View

18.

Vinchon M, Dhellemmes P . Craniopharyngiomas in children: recurrence, reoperation and outcome. Childs Nerv Syst. 2007; 24(2):211-7. DOI: 10.1007/s00381-007-0456-9. View

19.

Caldarelli M, Massimi L, Tamburrini G, Cappa M, Di Rocco C . Long-term results of the surgical treatment of craniopharyngioma: the experience at the Policlinico Gemelli, Catholic University, Rome. Childs Nerv Syst. 2005; 21(8-9):747-57. DOI: 10.1007/s00381-005-1186-5. View

20.

Fahlbusch R, Hofmann B . Surgical management of giant craniopharyngiomas. Acta Neurochir (Wien). 2008; 150(12):1213-26. DOI: 10.1007/s00701-008-0137-9. View