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.
MC, a 69-year-old female who following a head injury, was diagnosed with an incidental suprasellar cystic-solid mass. She remained asymptomatic for 4 years, subsequently developing diminished vision along with weight gain with an increase in lesion size. She underwent biopsy-aspiration of the cyst followed by Gamma Knife radiosurgery a month later. Subsequently 4 months later she developed a cyst recurrence on imaging and underwent Ommaya reservoir insertion, having no associated clinical changes. On follow-up, her MRI revealed an increase in the size of the cyst. Although further aspiration of the cystic component via the Ommaya reservoir was advised, she declined any intervention. Repeat imaging revealed a spontaneous decrease in the size of the cystic component that remained stable over time and required no further intervention.