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.
HS, a 46-year-old male presented with decreased vision in his left eye along with impotence and diminished energy levels of about 3 months duration. His endocrine evaluation revealed pan-hypopituitarism. He was diagnosed with a suprasellar mass, mixed solid-cystic [Figure and ] and underwent an image-guided stereotactic (using skull fiducials) brain biopsy and aspiration of the cyst, which contained about 4 cc of oily fluid. Histologic review revealed a papillary CP. One month later he underwent Gamma Knife radiosurgery on the residual tumor []. Postoperatively he did well with a gradual improvement in his vision and a decrease in tumor size as seen on imaging 5 years following initial treatment [Figure and ]. His pan-hypopituitarism remained stable and he is currently being managed with hormone replacement therapy. Six years following Gamma Knife stereotactic radiosurgery (GKRS) treatment, his tumor recurred and he underwent an extended transphenoidal surgery presently remaining free of radiographic tumor.