Transventricular Endoscopic Approach for Cystic Craniopharyngioma: Case Series

Abstract

Background and Study Aims The treatment of craniopharyngioma is varied. The treatment ranges from radical excision to direct radiotherapy. As the morbidity of excision is high, more conservative approaches are used. Transventricular endoscopy is a minimally invasive treatment for cystic craniopharyngiomas. The objective of this study is to describe personal experience with this method of treatment. Material and Methods This is retrospective review of series of patients managed with endoscopic catheter and reservoir placement for cystic craniopharyngiomas. Results Twenty nine patients presented with clinical features of raised intracranial features. Imaging showed a predominantly cystic craniopharyngioma extending into third ventricle with hydrocephalus. All patients underwent transcortical transventricular endoscopic biopsy, and catheter placement connected to reservoir. There was no morbidity ascribed to endoscopic procedure when fenestration and aspiration or fenestration and reservoir were placed. Twelve patients underwent radiotherapy. The median duration of follow-up was 18 months (3 - 72 months). Eight (27.5%) cases had recurrences. Five (17.2%) could be manged with only re-aspiration, two (6.8%) required craniotomy and resection and one (3.4%)could be managed only with ventriculoperitoneal shunt. Conclusion The neuroendoscopic fenestration, aspiration of cyst, and placement of catheter reservoir followed by radiation is an optional treatment for predominantly cystic craniopharyngiomas arising within or extending into the third ventricle causing hydrocephalus.