Neuroendoscopic Transventricular Approach for Cystic Craniopharyngioma

Abstract

The literature is rich with many studies reporting different treatment modalities and approaches for cystic craniopharyngioma (CC), including microsurgery, neuroendoscopic transventricular approach, endoscopic transnasal surgery, stereotactic drainage, and Ommaya reservoir insertion. The goals of this manuscript are to report the successful treatment of an atypical case of CC using the neuroendoscopic transventricular approach (NTVA) as well as discuss the different surgical modalities for these tumors following a comprehensive review of the literature. Our patient is a nine-year-old female with a large CC who was managed using the NTVA. No complications or recurrence occurred over two years of follow-up. Results of our literature review showed lower recurrence and complication rates of the NTVA compared to other surgical modalities. The NTVA is potentially efficient, reliable, and safe for managing CC and cysticdominant craniopharyngiomas, with low recurrence and complication rates compared to microsurgery and Ommaya reservoir insertion. Future randomized clinical studies comparing the various treatment modalities of CC are needed to solidify these conclusions.

Endoscopic resection of a giant colloid cyst in the velum interpositum: illustrative case

“… 13 Microsurgical methods with different approaches (such as transcallosal and transcortical transventricular) are suggested for large (> 20-mm) and giant (> 30-mm) symptomatic colloid cysts. Nonetheless, according to our case and similar cases, the endoscopic method could be an efficient, safe, and minimally invasive technique 5 with small-sized craniotomy, 14 even for GCC cases.…”

“…First, a tumor (e.g., pilocytic astrocytoma) or a cyst (arachnoid, colloid, inclusion, or teratoma cyst) with intralesion hemorrhage, and the second possible diagnosis was a cyst with mucinous or proteinous content (e.g., colloid cyst or craniopharyngioma). 5 , 6 Vascular lesions (e.g., aneurysm) due to location and MRA findings were not taken into consideration.…”

The Role of Surgical Approaches in the Multi-Modal Management of Adult Craniopharyngiomas

“…In cotrast, endoscopy was useful for predominantly intraventricular and/or hydrocephalus-causing lesions, in which the cyst wall could be fenestrated and marsupialized into the ventricles or basal cisterns. Indeed, endoscopic cyst fenestration with placement of a Ommaya reservoir has been well-described in the management of pediatric cystic craniopharyngiomas with or without hydrocephalus as a means to avoid the risks of aggressive surgical resection during childhood development [67][68][69][70]. Although not as well described, this approach has been applied in the adult population, particularly for patients with tumors deemed to be highly unresectable or with medical co-morbidites, precluding aggressive surgical intervention.…”