title: Malignant transformation of craniopharyngioma associated with moyamoya syndrome.
abstract: A 32-year-old man presented with malignant craniopharyngioma associated with moyamoya syndrome manifesting as right visual disturbance. Magnetic resonance (MR) imaging revealed a parasellar mass lesion diagnosed as adamantinomatous craniopharyngioma. He underwent three surgical procedures and repeated courses of radiotherapy, and was able to resume his daily life. MR imaging demonstrated tumor regrowth and bilateral occlusions of the internal carotid arteries (ICAs) with basal moyamoya phenomenon, which might have been induced by irradiation and/or tumor compression, 10 years after the initial manifestations. Sufficient debulking was safely achieved via the transsphenoidal route and histological examination revealed squamous cell carcinoma, indicating malignant transformation of craniopharyngioma. The tumor relapsed after only one month, so transsphenoidal tumor debulking was tried again. However, the postoperative course was unfavorable because of intraoperative bleeding from the right ICA. Malignant transformation of craniopharyngioma may be included in moyamoya syndrome. The treatment strategy should be carefully considered in such a complicated situation.
authors.affiliation: Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: Ujifuku
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsuo
authors.forename: Tomonori
authors.initials: T
authors.lastname: Takeshita
authors.forename: Yukishige
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashi
authors.forename: Naoki
authors.initials: N
authors.lastname: Kitagawa
authors.forename: Tomayoshi
authors.initials: T
authors.lastname: Hayashi
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Suyama
authors.forename: Izumi
authors.initials: I
authors.lastname: Nagata
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000473:pathology / Q000601:surgery; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D002533:Cerebral Angiography; D003131:Combined Modality Therapy; D003397:Craniopharyngioma / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D017809:Fatal Outcome; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery; D009072:Moyamoya Disease / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D009381:Neoplasms, Radiation-Induced / Q000473:pathology* / Q000601:surgery; D016609:Neoplasms, Second Primary / Q000473:pathology* / Q000601:surgery*; D038361:Neuronavigation; D010911:Pituitary Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D011183:Postoperative Complications / Q000473:pathology* / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D012086:Reoperation