Gangemi Michelangelo, Seneca Vincenzo, Mariniello Giuseppe, Colella Giuseppe, Magro Francesco
Department of Neurological Sciences, Division of Neurosurgery, Center of Excellence for Technological Innovation in Surgery ITC, Federico II University School of Medicine, Naples, Italy.
Clin Neurol Neurosurg. 2009 Jun;111(5):472-6. doi: 10.1016/j.clineuro.2009.01.002. Epub 2009 Feb 5.
Giant cystic craniopharyngiomas are rare lesions whose clinical and surgical management is extremely challenging, often requiring more than one craniotomy before obtaining a satisfying removal. We report one case of a giant cystic craniopharyngioma completely excised with a two-step combined use of a minimally invasive endoscopic approach followed by a single microsurgical transcranial procedure. A six-year-old boy presented with symptoms of increased intracranial pressure and posterior fossa involvement. Preliminary imaging revealed a large para- and suprasellar cystic tumor bulging superiorly into the third ventricle, and extending posteriorly from the retroclival region into the posterior fossa to the level of the foramen magnum. The suprasellar cystic quota was initially approached endoscopically through a right precoronal-transventricular approach and the cyst drained, while the remaining tumor was macroscopically totally removed one week later by a right pterional approach. A combined technique--endoscopic drainage followed by microsurgical removal--can be a valid alternative for the removal of giant cystic craniopharyngiomas in cases in which the cystic compartment bulges within the ventricular spaces, and may avoid multiple craniotomies.
巨大囊性颅咽管瘤是罕见的病变，其临床和手术治疗极具挑战性，通常需要进行不止一次开颅手术才能实现满意的切除。我们报告一例巨大囊性颅咽管瘤，通过微创内镜方法联合单次显微经颅手术分两步完全切除。一名6岁男孩出现颅内压升高和后颅窝受累症状。初步影像学检查显示，一个巨大的鞍旁和鞍上囊性肿瘤向上突入第三脑室，从斜坡后区域向后延伸至后颅窝枕大孔水平。最初通过右冠状前经脑室入路在内镜下处理鞍上囊性部分并引流囊肿，一周后通过右翼点入路将剩余肿瘤在肉眼下完全切除。对于囊性部分突入脑室间隙的巨大囊性颅咽管瘤，内镜引流联合显微手术切除的联合技术可能是一种有效的切除方法，并且可以避免多次开颅手术。
