Meshal Jarebi1, Alexandre Coutte2, Florence Bartier3, Yahya Khormi4, Johann Peltier5, Michel Lefranc5. 1. Department of Neurosurgery, Amiens Picardie University Medical Center, Amiens, France, jarebi.meshal@chu-amiens.fr. 2. Radiation Oncology Department, Amiens Picardie University Medical Center, Amiens, France. 3. Medical Physics Department, Amiens Picardie University Medical Center, Amiens, France. 4. Neurosurgery, Department of Surgery, Faculty of Medicine, Jazan University, Gizan, Saudi Arabia. 5. Department of Neurosurgery, Amiens Picardie University Medical Center, Amiens, France.
Abstract
BACKGROUND: Craniopharyngioma is a difficult entity to treat, which is particularly true for mixed craniopharyngioma (i.e., a mixture of both solid and cystic components). The present case report illustrates a minimally invasive, two-component, stereotactic treatment approach as an alternative to standard microsurgery. CASE DESCRIPTION: A 38-year-old patient presented with progressive intracranial hypertension followed by pan-hypopituitarism, deterioration of the visual field, and cognitive impairment. Brain MRI revealed hydrocephalus and a suprasellar mixed solid and polycystic lesion that was suggestive of craniopharyngioma. Using a robot-assisted, stereotactic treatment approach, we combined the installation of catheters for 2 Ommaya reservoirs with 5-fraction CyberKnife radiosurgery of the solid tumor. The high intracranial pressure and visual field deterioration resolved completely. A partial improvement in endocrine function was noted, and the patient returned to work 6 weeks after surgery. CONCLUSION: A combined, robot-assisted, stereotactic approach to the treatment of mixed (solid and polycystic) craniopharyngioma is a safe alternative to microsurgery. Further studies including larger numbers of patients will be needed to assess the long-term efficacy and morbidity and mortality rates associated with this approach.
BACKGROUND:Craniopharyngioma is a difficult entity to treat, which is particularly true for mixed craniopharyngioma (i.e., a mixture of both solid and cystic components). The present case report illustrates a minimally invasive, two-component, stereotactic treatment approach as an alternative to standard microsurgery. CASE DESCRIPTION: A 38-year-old patient presented with progressive intracranial hypertension followed by pan-hypopituitarism, deterioration of the visual field, and cognitive impairment. Brain MRI revealed hydrocephalus and a suprasellar mixed solid and polycystic lesion that was suggestive of craniopharyngioma. Using a robot-assisted, stereotactic treatment approach, we combined the installation of catheters for 2 Ommaya reservoirs with 5-fraction CyberKnife radiosurgery of the solid tumor. The high intracranial pressure and visual field deterioration resolved completely. A partial improvement in endocrine function was noted, and the patient returned to work 6 weeks after surgery. CONCLUSION: A combined, robot-assisted, stereotactic approach to the treatment of mixed (solid and polycystic) craniopharyngioma is a safe alternative to microsurgery. Further studies including larger numbers of patients will be needed to assess the long-term efficacy and morbidity and mortality rates associated with this approach.
Authors: Laura-Nanna Lohkamp; Abhaya V Kulkarni; James M Drake; James T Rutka; Peter B Dirks; Michael Taylor; George M Ibrahim; Jill Hamilton; Ute K Bartels Journal: J Neurooncol Date: 2022-08-04 Impact factor: 4.506