Craniopharyngiomas are benign tumors of the sellar and suprasellar region derived from epithelial cells of Rathke's pouch. They have a higher incidence in children and older adults. The most common symptoms are visual field alterations, hormonal deficits, and short stature in children. When these tumors cause hydrocephalus, they may present with headache, vomiting and altered consciousness.
The presumptive diagnosis is made via MRI and brain CT, where the typical suprasellar tumor — solid-cystic with calcifications — can be seen.
The best treatment for these tumors is complete resection when possible. We have radiotherapy as adjuvant therapy for active tumor remnants or for recurrent tumors.
Because craniopharyngiomas originate in the hypothalamic-pituitary axis, are primarily midline and are in intimate relationship with the skull base, the endoscopic endonasal approach is the most commonly chosen pathway, as it is the most direct to the region.
Our team prioritizes the endoscopic route as it allows for better visualization of the tumor and how it relates to the hypothalamic-pituitary axis, giving us every chance to achieve complete resection.
We present the case of a 20-year-old patient who consulted for progressive visual deficit accompanied by drowsiness due to cortisol deficiency. In this case we were able to perform a complete resection of the craniopharyngioma; the postoperative course was uneventful, complete hormonal replacement was carried out, and we did not need to use radiotherapy.
Note the high definition of the intraoperative images provided by the endoscopic endonasal approach. This visualization allows us to make the most appropriate decisions during surgery to deliver a good outcome.
