Purely Neuro-endoscopic Transventricular Approach forCystic Craniopharyngiomas

Background and Importance:

 Craniopharyngiomas are tumors made up of mixed components which can present intraventricular cystic portion. This study aimed at evaluating the outcome of endoscopic marsupialization as a surgical approach.

Methods and Materials/Patients:

 We report 11 cases presenting craniopharyngioma with intraventricular cystic portion inducing hydrocephalus managed at Neurosurgery Unit of Fann Hospital between June 2013 and June 2017. Endoscopic marsupialization was realized for all patients with a rigid neuroendoscope Karl Storz.

The mean age of cases was 30.18 years with a range of 07 to 69 years. There was a male predominance with a sex ratio of 1.75. All patients were suffering from intracranial pressure syndrome. Lowering visual acuate including two (02) blindness cases was found in patients under 15 years. Frontal lobe syndrome was found in all patients of more than 50 years. A cerebral CT scan was realized for 9 patients and an MRI for 4 patients. A cystic marsupialization with biopsy was realized by precoronal approach. Fluid looked like « waste oil » for 9 patients. Ventriculocisternostomy of the 3rd ventricle was realized in 2 cases. Progress was favorable with intracranial pressure signs disappearance in 8 cases. We noticed 3 failures with cyst persistence at control CT-Scan. Three patients had a recurrence, requiring revised marsupialization complicated by death in 1 case.

Endoscopic marsupialization represents a seductive technique which is easy and reproducible in the therapeutic procedure of intraventricular cystic craniopharyngioma.