Intracavitary Irradiation as a Safe Alternative for Cystic Craniopharyngiomas: Case Report and Review of the Literature

Abstract

Craniopharyngioma treatment remains a challenge for clinicians and patients. There are many treatment alternatives; however one of them (intracavitary irradiation) seeks to control this type of benign brain tumor using minimally invasive techniques, with the specific aim of avoiding causing significant damage to important structures surrounding the sellar/suprasellar region. We present the case of a 3-year-old patient with a predominantly cystic craniopharyngioma who underwent intracavitary irradiation by stereotactic placement. Using this approach, the patient showed a successful response with remission of headaches and hydrocephalus. A reduction in the size of the cyst was achieved, without deterioration of visual fields, with no hormonal supplementation being needed, and with no evidence of focal neurological signs.

Stereotactic Intracavitary Irradiation for Cystic Craniopharyngiomas with Rhenium-186

“…Stereotactic intracavitary irradiation has been used mostly for the treatment of cystic craniopharyngiomas, with satisfactory results. 3 Comparing the results of patients treated with stereotactic endocavitary irradiation for craniopharyngiomas, using yttrium-90 ( 90 Y) and 186 Re, Netzeband et al 12 observed better results with 90 Y, although the number of patients treated with 186 Re was too small to obtain statistical significance. Intracavitary irradiation was introduced by Leksell and Liden, 8 and standardized by Backlund, 9 employing radioac-tive chromic phosphate.…”

“…Stereotactic intracavitary irradiation has been used mostly for the treatment of cystic craniopharyngiomas, with satisfactory results. 3…”

“…Despite the benign histology, these tumors should be considered low-grade malignancies because of their location and progression without treatment, which generally results in a reduction in life expectancy and a 5-year overall survival rate of 80%. 3…”

“…Despite the benign histology, these tumors should be considered low-grade malignancies because of their location and progression without treatment, which generally results in a reduction in life expectancy and a 5-year overall survival rate of 80%. 3 In large series, 54% to 94,4% of the patients have tumors with a significant cystic portion. 4 Total surgical removal is the best option, but it may be associated with significant postoperative morbidity.…”