Giant craniopharyngioma with blindness reversed by surgery.

A 3-year-old boy presented with a 3-day history of total blindness. There were no features of raised intracranial pressure or endocrine disturbance. Magnetic resonance imaging of the brain showed a giant craniopharyngioma measuring 5 x 3 cm. It was located in the suprasellar region and produced a mass effect with compression of the III and both lateral ventricles. The tumour extended downwards into the pituitary fossa. Urgent surgical decompression and subtotal excision of the tumour resulted in complete visual recovery in the right eye. The left eye remained blind. The blindness might have been caused by direct pressure on the optic nerves and chiasma by the tumour. The lack of visual recovery in the left eye may be the consequence of additional ischaemic insult to the left optic nerve. It is concluded that surgical decompression should be carried out in a patient with a giant craniopharyngioma presenting with total blindness before the condition is considered hopeless.