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Intrinsic
third ventricular craniopharyngiomas: report on six cases and a review of the
literature
Behari S, Banerji D, Mishra A, Sharma S, Sharma S, Chhabra DK, Jain VK
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute
of Medical Sciences, Lucknow, India
Background. Craniopharyngiomas constitute 2 to 4% of intracranial
neoplasms.
However, the purely intraventricular variety are rare.
Their magnetic resonance imaging (MRI) characteristically shows an intact third
ventricular floor, a patent suprasellar cistern, an intact pituitary stalk, and
the absence of sellar abnormalities.
Methods.
Between 1994 and June 2002, 6 patients with purely intraventricular
craniopharyngioma were surgically managed.
There were 4 cystic and 2 solid lesions.
The surgical approaches utilized included a frontal, parasagittal, transcallosal
approach with the third ventricle being accessed using either the transforaminal
or subchoroidal approach (n = 3); pterional, transsylvian (n = 1), and bifrontal
interhemispheric (n = 2) approaches in which the third ventricle was accessed
via the lamina terminalis.
A ventriculoperitoneal shunt was required for one of the 3 patients with
hydrocephalus.
Results.
Total excision was performed in 3 patients with cystic craniopharyngioma, while
a small residual lesion was left adherent to the third ventricular floor in the
others.
There was one perioperative mortality because of septicemia.
Two patients required thyroxine supplementation.
Two patients developed transient and one other patient a sustained diabetes
insipidus.
The 2 patients with solid tumors received radiotherapy for the residual
lesions.
At follow up ranging from 8 to 36 months, neither tumor recurrence nor regrowth
was observed in any of the patients.
The symptoms of raised intracranial pressure, hypothalamic dysfunction or visual
field defects had resolved.
Conclusions.
Intraventricular craniopharyngiomas occur in an older population and present
mainly with raised intracranial pressure.
Visual and endocrinologic imbalances are much less in these lesions compared to
the suprasellar craniopharyngiomas.
They mainly attach to the third ventricular floor.
The surgical approaches to the third ventricle, along with radiotherapy and
hormone supplementation, were successful in the management of these rare tumors.
PMID: 12922045 [PubMed - in process]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12922045&dopt=Abstract
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