title: Combined endoscopic and microsurgical removal of a giant cystic craniopharyngioma in a six-year-old boy.
abstract: Giant cystic craniopharyngiomas are rare lesions whose clinical and surgical management is extremely challenging, often requiring more than one craniotomy before obtaining a satisfying removal. We report one case of a giant cystic craniopharyngioma completely excised with a two-step combined use of a minimally invasive endoscopic approach followed by a single microsurgical transcranial procedure. A six-year-old boy presented with symptoms of increased intracranial pressure and posterior fossa involvement. Preliminary imaging revealed a large para- and suprasellar cystic tumor bulging superiorly into the third ventricle, and extending posteriorly from the retroclival region into the posterior fossa to the level of the foramen magnum. The suprasellar cystic quota was initially approached endoscopically through a right precoronal-transventricular approach and the cyst drained, while the remaining tumor was macroscopically totally removed one week later by a right pterional approach. A combined technique--endoscopic drainage followed by microsurgical removal--can be a valid alternative for the removal of giant cystic craniopharyngiomas in cases in which the cystic compartment bulges within the ventricular spaces, and may avoid multiple craniotomies.
authors.affiliation: Department of Neurological Sciences, Division of Neurosurgery, Center of Excellence for Technological Innovation in Surgery ITC, Federico II University School of Medicine, Naples, Italy. mgangemi@unina.it
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Gangemi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Seneca
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mariniello
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Colella
authors.forename: Francesco
authors.initials: F
authors.lastname: Magro
mesh_terms: D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D002648:Child; D003397:Craniopharyngioma / Q000473:pathology / Q000601:surgery*; D004724:Endoscopy; D006801:Humans; D015192:Infratentorial Neoplasms / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery; D019635:Neurosurgical Procedures; D014057:Tomography, X-Ray Computed