Intracranial Craniopharyngioma Seeding following Radical Resection

Abstract

A rare case of intracranial seeding from a craniopharyngioma is presented. A 12-year-old boy underwent radical resection of a suprasellar craniopharyngioma 2 years previously. There had been no evidence of recurrence during follow-up. He became symptomatic 1 week prior to admission, when imaging showed a recurrent tumor. The metastatic, subfrontal craniopharyngioma was not anatomically connected to the suprasellar region, but originated from the floor of the anterior fossa along the former surgical approach. The significance of this finding and its relation to recurrent craniopharyngioma is discussed.

Metastatic papillary craniopharyngioma: Case study and study of tumorangiogenesis

“…Either tumor may be cystic, solid, or both (Burger et al, 1994). Despite their benign histology, craniopharyngiomas may rarely recur as a result of implantation along the operative tract or as remote deposits or metastases due to cerebrospinal uid spread (Barloon et al, 1988;Gupta et al, 1999;Israel and Pomeranz, 1995;Ito et al, 2001;Lee et al, 1999;Malik et al, 1992;Ragoowansi and Piepgras, 1991). Our case is an example of the latter-a leptomeningeal metastasis opposite the side of the craniotomy that presented 2 years after removal of the primary tumor.…”

“…The literature cites only 5 "ectopic" recurrences, all along the tract of the surgical route and presumably the result of operative implantation (Barloon et al, 1988;Israel and Pomeranz, 1995;Lee et al, 1999;Ragoowansi and Piepgras, 1991). An epidural craniopharyngioma recurrence, physically separate from the primary site but ipsilateral to the cran-iotomy, has also been reported (Malik et al, 1992).…”

Surgical treatment of ectopic recurrence of craniopharyngioma

“…Remote recurrence following surgery is reported as a rare phenomenon, and only 28 cases have been reported in the literature (Table 4). Such occurrences have been attributed to tumor seeding along the tract made by repeated aspirations, 4 local "seeds" of tumor left behind along the surgical corridor, 7,8,18,19,23,25,[33][34][35]43,47,55 and dissemination within the CSF into the intracranial subarachnoid, 3,6,7,15,21,24,29,30,42,54,61 Virchow-Robin, 8,43 and intraventricular spaces 20 or the lumbar cistern. 32 Importantly, Nomura et al 42 demonstrated seeding of the CSF after discovering craniopharyngioma cells on cytological analysis.…”

“…5,8,10,12,13,16,17,22,26,27,30,37,38,44,50,55,56,60,62,63 Although most recurrences occur locally-in or adjacent to the suprasellar cistern-ectopic recurrence of craniopharyngioma can occur in the presence or absence of suprasellar disease. Two common patterns of ectopia are along the surgical tract 4,7,8,18,19,23,25,[33][34][35]43,47,55 and dissemination via the CSF into the cortical subarachnoid, 3,6,7,15,21,24,29,30,42,54,61 Virchow-Robin, 8,43 and intraventricular spaces 20 or the lumbar cistern. 32 A retrospective analysis was performed in 86 consecutive children with craniopharyngiomas who underwent 103 operations for radical resection by the...…”

Ectopic Recurrence of Craniopharyngioma-Case Report-

“…[1][2][3][4][5][6][7][8][9][10][11]13,14,16) The nine male and six female patients were aged 2 to 73 years (mean 36.3 years). The primary craniopharyngioma was located in the suprasellar region in all cases.…”