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 ).
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.