Cases reported "Craniopharyngioma"

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1/7. craniopharyngioma involving supfrasellar region and sphenoid sinus: case report.

    Craniopharyngiomas are benign, epithelial, slow-growing neoplasms that generally develop either in the suprasellar region or in both the suprasellar and intrasellar regions. They rarely occurs in the infrasellar region. Based on embryologic development of adenohypophysis, the tumor can arise along the path of the craniopharyngeal duct. We report on an 8- year-old boy who presented to us with headache and anorexia for several weeks during May 1999. brain MRI revealed a huge sphenoid tumor. The tumor was completely excised by functional endoscopic sinus surgery on 12th August 1999. The postoperative course was smooth and no evidence of tumor recurrence was found on his latest follow-up visit in February, 2000. From the clinical experience with this case, functional endoscopic sinus surgery is an alternative and a less-harmful surgical procedure for this kind of benign sphenoid tumor. Moreover, embryology development, epidemiology, clinical presentation, diagnostic method and treatment of craniopharyngioma are discussed.
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2/7. Neuroendoscopic placement of Ommaya reservoir into a cystic craniopharyngioma.

    INTRODUCTION: Total removal of the tumor is the most acceptable therapeutic modality in the management of craniopharyngioma; however, there are innumerable factors that can upset treatment plans. Unresectable lesions are often treated with gamma knife surgery (GKS). Reduction of the cystic volume is necessary, to decrease the area to be treated with GKS. An Ommaya reservoir system is usually placed during open surgery or by stereotactic access. MATERIALS AND methods: The authors use a neuroendoscope for safer and less invasive placement of the Ommaya reservoir into deep-seated cystic lesions. The cystic component is aspirated, and the Ommaya reservoir tube is precisely guided and placed into the cyst cavity under neuroendoscopic control with a newly developed two-burr-hole technique. This neuroendoscopic procedure could make it easier to reduce cystic volume prior to GKS as the final procedure. This technique may also be used for instillation of chemotherapeutic agents and for repeat aspirations, making the achievement of cystic control more likely. This type of neuroendoscopic management is a safe and effective procedure and could be considered as an alternative management technique for some stubborn cystic craniopharyngiomas.
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3/7. Neuroendoscopic stent procedure in obstructive hydrocephalus due to both foramina of monro occluding craniopharyngioma: technical note.

    BACKGROUND: The development of various neuroendoscopic surgical instruments has offered more options for endoscopic procedures in the treatment of intraventricular tumors. Not only tumor biopsy or tumor resection but also restoration of an obstructed cerebral spinal fluid (CSF) pathway can be performed using the same approach. METHOD: A 76-year-old woman with a cardiac pacemaker for an underlying heart disease was diagnosed with obstructive hydrocephalus because of a third ventricular tumor 8 years ago. The patient had been treated with ventriculo-peritoneal shunt placement. At admission she presented with a subcutaneous infection of the shunt catheter and an abdominal mass of unknown etiology. Neuroendoscopic stenting between lateral and third ventricle was performed to restore the obstructed CSF pathway, and the infected shunt system was removed in the same setting. RESULT: The postoperative course was uneventful. Contrast ventriculography demonstrated a restored CSF pathway between the lateral and third ventricle. Histologic examination of the intraventricular tumor revealed a craniopharyngioma, and the abdominal mass was diagnosed as a gastrointestinal adenocarcinoma. CONCLUSION: The neuroendoscopic foraminoplasty technique should be considered as an alternative treatment for patients who present with an obstructive hydrocephalus caused by a tumor that occludes both foramina of Monro when shunt placement or endoscopic third ventriculostomy is not feasible.
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4/7. Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases.

    OBJECTIVE: The traditional boundaries of the transsphenoidal approach may be expanded to include the region from the cribriform plate of the anterior cranial base to the inferior clivus in the anteroposterior plane, and laterally to expose the cavernous cranial nerves and the optic canal. We review our combined experience with these variations on the transsphenoidal approach to various lesions of the sellar and parasellar region. methods: From 1982 to 2003, we used the extended and parasellar transsphenoidal approaches in 105 patients presenting with a variety of lesions of the parasellar region. This study specifically reviews the breadth of pathological lesions operated and the complications associated with the approaches. RESULTS: Variations of the standard transsphenoidal approach have been used in the following series: 30 cases of pituitary adenomas extending laterally to involve the cavernous sinus, 27 craniopharyngiomas, 11 tuberculum/diaphragma sellae meningiomas, 10 sphenoid sinus mucoceles, 18 clivus chordomas, 4 cases of carcinoma of the sphenoid sinus, 2 cases of breast carcinoma metastatic to the sella, and 3 cases of monostotic fibrous dysplasia involving the clivus. There was no mortality in the series. Permanent neurological complications included one case of monocular blindness, one case of permanent diabetes insipidus, and two permanent cavernous cranial neuropathies. There were four cases of internal carotid artery hemorrhage, one of which required ligation of the cervical internal carotid artery and resulted in hemiparesis. The incidence of postoperative cerebrospinal fluid fistulae was 6% (6 of 105 cases). CONCLUSION: These modifications of the standard transsphenoidal approach are useful for lesions within the boundaries noted above, they offer excellent alternatives to transcranial approaches for these lesions, and they avoid prolonged exposure time and brain retraction. Technical details are discussed and illustrative cases presented.
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5/7. Therapeutic benefits of combination chemotherapy with vincristine, BCNU, and procarbazine on recurrent cystic craniopharyngioma. A case report.

    The authors report a case of recurrent cystic craniopharyngioma managed with chemotherapy. The patient refused adamantly the alternative therapy methods, such as surgery and radiotherapy, initially offered. Eight courses of chemotherapy with vincristine (2 mg/M2, i.v.) on day 1,1,3-bis(2-chloroethyl)-1-nitrosourea (100 mg/M2, i.v.) on day 2, and procarbazine (50 mg, b.i.d., p.o.) on days 3 to 21 were administered at 6 week intervals. The effectiveness of this treatment modality has been evaluated by the unequivocal neurological improvement and by the decreases in size of the cyst using serial computerized tomography. Toxocities were mild and chiefly hematological.
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6/7. Management of the unresectable cystic craniopharyngioma by aspiration through an Ommaya reservoir drainage system.

    Four patients with primary and recurrent craniopharyngiomas that were grossly cystic were managed by intermittent aspiration through an indwelling Ommaya reservoir apparatus. The technique is safe and provides a reasonable alternative for the amelioration of signs and symptoms when total extirpation of the tumor is impossible.
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7/7. Endoscopic management of craniopharyngiomas: a review of 3 cases.

    The authors describe the endoscopic management of cystic craniopharyngiomas in 3 cases. This method has been attempted in cystic craniopharyngiomas using a rigid endoscope. The instrument has been described earlier (7-9). All these operations were done under general anaesthesia. Criteria for endoscopic extirpation and removal included type D, E, F classification according to Yasargil (17). All 3 cases fitted in the F category. There were one female and two male patients. In the female patient an aspiration of cyst contents was performed as a first attempt to relieve her hydrocephalus. Two months later recurrent symptomology necessitated a larger intervention. All cysts were opened using the laser, drained by a Fogarthy balloon-catheter, and the capsule removed by forceps. This technique is safe and provides a reasonable alternative to open microsurgery, radioactive isotope instillation, or radiotherapy. In our series we achieved total removal in one case after the second intervention and partial removal in two cases. There was no mortality directly associated with this procedure and the female patient developed severe electrolyte disturbances after macroscopic total removal. Our results suggest that endoscopic of management of cystic craniopharyngiomas is a safe and effective procedure which could be considered as the initial management for cystic craniopharyngiomas of the intraventricular type.
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