A 79-year-old female presented with a complaint of visual disturbances over the past eight months. Signed informed patient consent was obtained prior to treatment. Upon examination, the patient was found to have a visual loss in her left eye, normal endocrine function, and intact mental status. MRI with the injection of contrast media revealed a lobulated cystic lesion centered in the suprasellar cistern measuring 2.2 x 1.6 x 2.0 cm (AP x transverse x CC). The mass demonstrated broad vascular contact with the circle of Willis as well as a mass effect on the optic chiasm, left optic nerve, and pituitary gland (Figures -). CT revealed several small foci of calcification.\nThe patient underwent endoscopic endonasal transsphenoidal resection of the tumor using a transtuberculum approach [-]. The tumor was identified and removed from the anterior skull base with no evidence of residual tumor. A gasket seal closure was used, covered by nasoseptal flap [-]. A lumbar drain was left in place for 24 hours. Postoperative MRI confirmed gross total resection of the tumor (Figures -). The diagnosis from surgical pathology was craniopharyngioma, WHO Grade 1.\nThe patient did not have any complications from the procedure and was found not to have diabetes insipidus postoperatively. She did not require hormone replacement and was cleared for discharge home two days after undergoing surgery. She also reported subjective improvement in her vision.
A 75-year-old woman with a known intracranial mass referred to our outpatient clinic. The lesion was incidentally discovered after a head computed tomography (CT) scan that she had in the past for the evaluation of a confusion episode secondary to hypoglycemia (diabetes mellitus being the only comorbidity in this patient). Magnetic resonance imaging (MRI) of her brain revealed a cystic sellar mass with mass effect on the right lateral ventricle []. The patient had ophthalmologic and endocrinologic evaluations that demonstrated a left temporal, a right superior temporal visual field deficit, and panhypopituitarism. Based on these imaging and clinical findings, the diagnosis of a craniopharyngioma was made. She was then placed on steroid therapy as well as hormone replacement therapy, and surgical resection was planned. In the interim, she began developing severe lower extremity weakness that delayed surgery. A diagnosis of steroid-induced myopathy was made.\nImmediately after the evaluation of her lower extremity weakness, the patient presented to the ED with an acute onset of altered mental status. Her Glasgow Coma Scale (GCS) score on initial presentation was 10. Noncontrast head CT imaging demonstrated changes in the density of the cyst and the density of the ventricular cerebrospinal fluid (CSF) []. Subsequent MRI of the brain was strongly suggestive of intraventricular rupture of the cyst []. Intraventricular cyst rupture was confirmed by a lumbar puncture that demonstrated marked pleocytosis with elevated levels of cholesterol and lactate dehydrogenase identified by CSF analysis. Given these findings, a diagnosis of chemical ventriculitis was made.\nThe patient was initially started on high-dose steroid therapy with significant improvement of her level of consciousness (GCS: 13/15). Once her clinical condition was medically optimized, the patient was taken to the operating room for endoscopic-assisted intracystic placement of an Ommaya reservoir []. Cytopathologic analysis of the aspirate revealed proteinaceous material, blood, and histiocytes, some with hemosiderin. She underwent shunt placement for continued ventriculomegaly 5 days after Ommaya reservoir placement. Her condition improved, and she was discharged from the Intensive Care Unit within 2 weeks from her admission.