The patient is a nine-year-old female who presented with headache, agitation, urinary frequency, and progressive visual deficits over the past two years. A large sellar and suprasellar lesion was detected on a CT scan, and a ventriculoperitoneal (VP) shunt was placed to relieve the progressive symptoms of hydrocephalus (Figure ). MRI solidified the initial suspicion of CC, where the lesion was hyperintense on T1- and T2-weighted images, without any significant, enhancing solid component on postcontrast T1-weighted images, consistent with the high protein and cholesterol contents of CC (Figure ).\nA few days prior to surgery and despite no signs of VP shunt failure, the patient’s exam was notable for acute confusion, severe ataxia, and bilateral blindness. The NTVA was performed using a rigid neuroendoscope (Aesculap AG, Tuttlingen, Germany). The cyst was accessed through a right frontal burr hole, and the contents were drained. The neuroendoscope was advanced to the right lateral ventricle, where cyst wall calcifications were visible through the thinned and elevated neural elements. The choroid plexus was then identified and tracked back to the foramen of Monro. The cyst wall was sampled and the cyst was punctured, draining a copious gray-to-green liquid content with debris. Simultaneous irrigation with a Ringer’s solution and suctioning cleared the contents of the cyst; adjacent neurovascular structures were clearly visible at the end of the procedure.\nThe postoperative course was uneventful, and all symptoms improved in the immediate postoperative period, except for visual loss. Histopathology confirmed the diagnosis of CC. The patient did not develop any symptoms of chemical meningitis on close follow-up. Her pituitary function remained normal postoperatively as well as on long-term follow-up. We opted not to pursue any additional surgical or adjuvant therapy due to the lack of any obvious solid tumor component on postoperative MRI, very thin residual cyst wall, and extensive basal extension with involvement of the critical structures (Figure ). Follow-up MRIs showed no evidence of tumor regrowth or re-accumulation of cystic contents (Figure ).
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.