The microsurgical advantage of huge cystic craniopharyngioma following long-term cystic aspirations via Ommaya reservoir: A case report.

RATIONALE

Craniopharyngiomas are histologically benign tumors with a relatively high recurrence rate. Surgical removal is challenging due to proximity to critical brain structures. This report introduces a staged operation strategy for a huge cystic craniopharyngioma.

PATIENT CONCERNS

An 8-year-old girl presented with diplopia and decreased visual acuity.

DIAGNOSES

Brain magnetic resonance imaging revealed a large, 10-cm-sized cystic mass encasing both the anterior and middle cerebral arteries and the optic nerve.

INTERVENTIONS

An Ommaya reservoir was placed for periodic cyst aspirations over a period of 15 months. Subsequent magnetic resonance imaging indicated a reduction in cyst size, with an increasingly distinct tumor-pial interface evident on T2-weighted images. The tumor, initially entwined with neurovascular structures, gradually became delineated from these critical components. She underwent a secondary surgical intervention utilizing a bifrontal interhemispheric approach. Intraoperatively, the tumor was meticulously dissected and totally excised without compromising surrounding critical structures, while the tumor's origin, the pituitary stalk, underwent partial resection.

OUTCOMES

There was no worsening of vision after surgery. She was on minirin medication, and there was no recurrence during the 1-year follow-up.

LESSONS

Microsurgery of huge cystic craniopharyngioma following long-term cyst aspirations via Ommaya reservoir could present an efficacious strategy to diminish complication risks in pediatric patients.