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J Neurol Surg B Skull Base 2023; 84(06): 591-597
DOI: 10.1055/a-1934-9307
Original Article

Transventricular Endoscopic Approach for Cystic Craniopharyngioma: Case Series

Akshay Kulkarni 
1   Department of Neurosurgery, University of Illinois, Chicago, Illinois, United States
,
Subhas Konar 
2   Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
,
Dhaval Shukla 
2   Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
,
Nishanth Sadashiva 
2   Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
,
Bhagavatula Indira Devi 
2   Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
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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 a personal experience with this method of treatment.

Material and Methods This is a retrospective review of a 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 the third ventricle with hydrocephalus. All patients underwent transcortical transventricular endoscopic biopsy, and catheter placement connected to a reservoir. There was no morbidity ascribed to the 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 managed with only reaspiration, 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.

Keywords

endoscopy - neuroendoscopy - hydrocephalus - craniopharyngioma - reservoir


Publication History

Received: 04 June 2022

Accepted: 29 August 2022

Accepted Manuscript online:
31 August 2022

Article published online:
01 November 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Hoffmann A, Warmth-Metz M, Gebhardt U. et al. Childhood craniopharyngioma - changes of treatment strategies in the trials KRANIOPHARYNGEOM 2000/2007. Klin Padiatr 2014; 226 (03) 161-168
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Ali ZS, Bailey RL, Daniels LB. et al. Comparative effectiveness of treatment options for pediatric craniopharyngiomas. J Neurosurg Pediatr 2014; 13 (02) 178-188
    CrossrefPubMedGoogle Scholar
  • 3 Muller HL. Childhood craniopharyngioma. Recent advances in diagnosis, treatment and follow-up. Horm Res 2008; 69 (04) 193-202
    PubMedGoogle Scholar
  • 4 Barajas MA, Ramírez-Guzmán G, Rodríguez-Vázquez C. et al. Multimodal management of craniopharyngiomas: neuroendoscopy, microsurgery, and radiosurgery. J Neurosurg 2002; 97 (5, Suppl): 607-609
    CrossrefPubMedGoogle Scholar
  • 5 Delitala A, Brunori A, Chiappetta F. Purely neuroendoscopic transventricular management of cystic craniopharyngiomas. Childs Nerv Syst 2004; 20 (11-12): 858-862
    CrossrefPubMedGoogle Scholar
  • 6 Gutin PH, Klemme WM, Lagger RL, MacKay AR, Pitts LH, Hosobuchi Y. Management of the unresectable cystic craniopharyngioma by aspiration through an Ommaya reservoir drainage system. J Neurosurg 1980; 52 (01) 36-40
    CrossrefPubMedGoogle Scholar
  • 7 Mori R, Joki T, Nonaka Y, Ikeuchi S, Abe T. Parallel insertion endoscopic technique for precise catheter placement in cystic craniopharyngiomas. J Neurol Surg A Cent Eur Neurosurg 2014; 75 (06) 442-446
    PubMedGoogle Scholar
  • 8 Zanon N, Cavalheiro S, da Silva MC. Does the choice of surgical approach to insert an intratumoral catheter influence the results of intratumoral cystic treatment?. Surg Neurol 2008; 70 (01) 66-69 , discussion 69
    CrossrefPubMedGoogle Scholar
  • 9 Pettorini BL, Tamburrini G, Massimi L, Caldarelli M, Di Rocco C. Endoscopic transventricular positioning of intracystic catheter for treatment of craniopharyngioma. Technical note. J Neurosurg Pediatr 2009; 4 (03) 245-248
    CrossrefPubMedGoogle Scholar
  • 10 Konar S, Singha S, Shukla D. Transventricular endoscopic management of a suprasellar cystic craniopharyngioma. In: SGPGI, ed. The Operative Atlas of Neurosurgery: A Compendium of 120 Neuro-Oncological, Case-Based, Surgical Approaches. Vol. II Thieme Publishers, India; 2020: 1261-1270
    Google Scholar
  • 11 Shukla D. Transcortical transventricular endoscopic approach and Ommaya reservoir placement for cystic craniopharyngioma. Pediatr Neurosurg 2015; 50 (05) 291-294
    CrossrefPubMedGoogle Scholar
  • 12 Hellwig D, Bauer BL, List-Hellwig E. Stereotactic endoscopic interventions in cystic brain lesions. Acta Neurochir Suppl (Wien) 1995; 64: 59-63
    CrossrefPubMedGoogle Scholar
  • 13 Dufour H, Fuentes S, Metellus P, Grisoli F. Preoperative endoscopic treatment of hydrocephalus due to cystic craniopharyngioma. (Abstract) Childs Nerv Syst 2003; 19 (09) 693
    PubMedGoogle Scholar
  • 14 Nakahara Y, Koga H, Maeda K, Takagi M, Tabuchi K. Neuroendoscopic transventricular surgery for suprasellar cystic mass lesions such as cystic craniopharyngioma and Rathke cleft cyst. Neurol Med Chir (Tokyo) 2004; 44 (08) 408-413 , discussion 414–415
    CrossrefPubMedGoogle Scholar
  • 15 Nicolato A, Foroni R, Rosta L, Gerosa M, Bricolo A. Multimodality stereotactic approach to the treatment of cystic craniopharyngiomas. Minim Invasive Neurosurg 2004; 47 (01) 32-40
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Locatelli D, Levi D, Rampa F, Pezzotta S, Castelnuovo P. Endoscopic approach for the treatment of relapses in cystic craniopharyngiomas. Childs Nerv Syst 2004; 20 (11-12): 863-867
    CrossrefPubMedGoogle Scholar
  • 17 Kamikawa S, Inui A. Pediatric malignancies. Case 3. Craniopharyngioma in a 4-year-old girl: neuroendoscopic diagnosis and treatment. J Clin Oncol 2005; 23 (21) 4793-4794
    CrossrefPubMedGoogle Scholar
  • 18 Kuramoto T, Uchikado H, Tajima Y, Tokutomi T, Shigemori M. Neuroendoscopic placement of the reservoir in an elderly patient with recurrenced craniopharyngioma: case report [in Japanese]. No Shinkei Geka 2005; 33 (12) 1207-1212
    PubMedGoogle Scholar
  • 19 Cinalli G, Spennato P, Cianciulli E, Fiorillo A, Di Maio S, Maggi G. The role of transventricular neuroendoscopy in the management of craniopharyngiomas: three patient reports and review of the literature. J Pediatr Endocrinol Metab 2006; 19 (Suppl 1): 341-354
    PubMedGoogle Scholar
  • 20 Tirakotai W, Hellwig D, Bertalanffy H, Riegel T. The role of neuroendoscopy in the management of solid or solid-cystic intra- and periventricular tumours. Childs Nerv Syst 2007; 23 (06) 653-658
    CrossrefPubMedGoogle Scholar
  • 21 Sato K, Oka H, Utsuki S, Fujii K. Repeated neuroendoscopic palliative surgery in elderly patients with predominantly cystic craniopharyngioma in the third ventricle: three case reports. Innov Neurosurg 2013; 1 (01) 67-72
    CrossrefPubMedGoogle Scholar
  • 22 Abdullah J, Caemaert J. Endoscopic management of craniopharyngiomas: a review of 3 cases. Minim Invasive Neurosurg 1995; 38 (02) 79-84
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Gaab MR, Schroeder HW. Neuroendoscopic approach to intraventricular lesions. J Neurosurg 1998; 88 (03) 496-505
    CrossrefPubMedGoogle Scholar
  • 24 Macarthur DC, Buxton N, Vloeberghs M, Punt J. The effectiveness of neuroendoscopic interventions in children with brain tumours. Childs Nerv Syst 2001; 17 (10) 589-594
    CrossrefPubMedGoogle Scholar
  • 25 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 (02) 85-87
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Joki T, Oi S, Babapour B. et al. Neuroendoscopic placement of Ommaya reservoir into a cystic craniopharyngioma. Childs Nerv Syst 2002; 18 (11) 629-633
    CrossrefPubMedGoogle Scholar
  • 27 El-Shafei HI, Abou El-Nasr AH, Kamal H. Rigid neuroendoscopy in management of pathologies related to the third ventricle and associated with hydrocephalus. Egypt J Neurosurg 2008; 23 (02) 255-264
    PubMedGoogle Scholar
  • 28 Novák Z, Chrastina J, Feitová V, Lžičařová E, Říha I. Možnosti neuroendoskopie v komplexní terapii kraniofaryngeomů. Onkologie 2009; 3 (03) 194-197
    PubMedGoogle Scholar
  • 29 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 (05) 1305-1315
    CrossrefPubMedGoogle Scholar
  • 30 Park YS, Chang JH, Park YG, Kim DS. Recurrence rates after neuroendoscopic fenestration and Gamma Knife surgery in comparison with subtotal resection and Gamma Knife surgery for the treatment of cystic craniopharyngiomas. J Neurosurg 2011; 114 (05) 1360-1368
    CrossrefPubMedGoogle Scholar
  • 31 Gangemi M, Seneca V, Mariniello G, Colella G, Magro F. Combined endoscopic and microsurgical removal of a giant cystic craniopharyngioma in a six-year-old boy. Clin Neurol Neurosurg 2009; 111 (05) 472-476
    CrossrefPubMedGoogle Scholar
  • 32 Tirakotai W, Schulte DM, Bauer BL, Bertalanffy H, Hellwig D. Neuroendoscopic surgery of intracranial cysts in adults. Childs Nerv Syst 2004; 20 (11-12): 842-851
    CrossrefPubMedGoogle Scholar
  • 33 Fujimoto Y, Fujimoto Y, Kato A, Yoshimine T. Neuroendoscopic palliation for large cystic craniopharyngioma in an elderly patient. Br J Neurosurg 2007; 21 (06) 618-621
    CrossrefPubMedGoogle Scholar
  • 34 Yaşargil MG, Curcic M, Kis M, Siegenthaler G, Teddy PJ, Roth P. Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients. J Neurosurg 1990; 73 (01) 3-11
    CrossrefPubMedGoogle Scholar
  • 35 Konar SK, Kulkarni AV, Shukla D. et al. Management options for suprasellar cystic craniopharyngioma: endoscopic transventricular approach and microsurgical approach. J Neurosci Rural Pract 2021; 12 (02) 343-349
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Shoubash LI, El Refaee E, Al Menabbawy A, Refaat MI, Fathalla H, Schroeder HWS. Endoscopic transcortical-transventricular approach in treating third ventricular craniopharyngiomas-case series with technical note and literature review. Oper Neurosurg (Hagerstown) 2022; 22 (04) 192-200
    CrossrefPubMedGoogle Scholar
  • 37 Jaiswal S, Jaiswal M, Jaiswal P. et al. Endoscopic transcortical transventricular management of cystic craniopharyngioma: outcome analysis of 32 cases at a tertiary care center. Asian J Neurosurg 2020; 15 (04) 846-855
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 Frio F, Solari D, Cavallo LM, Cappabianca P, Raverot G, Jouanneau E. Ommaya reservoir system for the treatment of cystic craniopharyngiomas: surgical results in a series of 11 adult patients and review of the literature. World Neurosurg 2019; 132: e869-e877
    CrossrefPubMedGoogle Scholar
  • 39 Lauretti L, Legninda Sop FY, Pallini R, Fernandez E, D'Alessandris QG. Neuroendoscopic treatment of cystic craniopharyngiomas: a case series with systematic review of the literature. World Neurosurg 2018; 110: e367-e373
    CrossrefPubMedGoogle Scholar
  • 40 Yasumoto Y, Ito M. Asymptomatic spontaneous rupture of craniopharyngioma cyst. J Clin Neurosci 2008; 15 (05) 603-606
    CrossrefPubMedGoogle Scholar
  • 41 Ito M, Jamshidi J, Yamanaka K. Does craniopharyngioma metastasize? Case report and review of the literature. Neurosurgery 2001; 48 (04) 933-935 , discussion 935–936
    PubMedGoogle Scholar
  • 42 Elliott RE, Jane Jr JA, Wisoff JH. Surgical management of craniopharyngiomas in children: meta-analysis and comparison of transcranial and transsphenoidal approaches. Neurosurgery 2011; 69 (03) 630-643 , discussion 643
    CrossrefPubMedGoogle Scholar
  • 43 Wisoff J, Donahue B. Craniopharyngioma. In: Albright AL, Pollack IF, Adelson PD, eds. Principles and Practice of Pediatric Neurosurgery. 3rd ed. Thieme, USA; 2015: 483-502
    Google Scholar