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. 2021 Sep 20;13(9):e18123. doi: 10.7759/cureus.18123

Neuroendoscopic Transventricular Approach for Cystic Craniopharyngioma

Mohammad Hassan A Noureldine 1, Sajjad Khodmehr 2, Mohammadmahdi Sabahi 3, Puya Alikhani 4, George I Jallo 5, Mahdi Arjipour 6,7,✉
Editors: Alexander Muacevic, John R Adler
PMCID: PMC8528039  PMID: 34692333

Abstract

The literature is rich with many studies reporting different treatment modalities and approaches for cystic craniopharyngioma (CC), including microsurgery, neuroendoscopic transventricular approach, endoscopic transnasal surgery, stereotactic drainage, and Ommaya reservoir insertion. The goals of this manuscript are to report the successful treatment of an atypical case of CC using the neuroendoscopic transventricular approach (NTVA) as well as discuss the different surgical modalities for these tumors following a comprehensive review of the literature. Our patient is a nine-year-old female with a large CC who was managed using the NTVA. No complications or recurrence occurred over two years of follow-up. Results of our literature review showed lower recurrence and complication rates of the NTVA compared to other surgical modalities.The NTVA is potentially efficient, reliable, and safe for managing CC and cystic-dominant craniopharyngiomas, with low recurrence and complication rates compared to microsurgery and Ommaya reservoir insertion. Future randomized clinical studies comparing the various treatment modalities of CC are needed to solidify these conclusions.

Keywords: ommaya reservoir, microsurgery, neuroendoscopy, cystic, craniopharyngioma

Introduction

Craniopharyngiomas arise from squamous cells of Rathke’s pouch. These benign tumors account for 10% of pediatric and 2-4% of intracranial brain tumors, are located in the intra- and suprasellar zones, and are classified as cystic, solid, or mixed [1]. Tumoral attachment to critical neurovascular tissue, such as the hypothalamus or pituitary, is a treatment challenge. Although endocrine dysfunction could be seen in total resections, the risk is increased in partial resections as well [2]. Total or partial surgical resection remains the treatment of choice, and radiation therapy may play a role in partial resections or recurrences. Neuroendoscopic transventricular fenestration and placement of an intracystic catheter with an Ommaya reservoir is a valid, minimally invasive technique in the management of large cystic craniopharyngiomas (CC) [3-4]. The objectives of this paper are to report the management of an atypical CC using the neuroendoscopic transventricular approach (NTVA), as well as discuss the different surgical modalities for these tumors following a review of the literature.

Case presentation

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 1). 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 2).

Figure 1. Head CT scan images reveal a massive cystic lesion with extension from the anterior to posterior fossa and upward to the lateral ventricles.

Figure 1

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Cystic contents are iso-to-hypodense and peripheral punctate calcifications (arrows) are evident (A-C). Diffuse periventricular hypodensity due to interstitial edema (D, arrow) initially persisted despite shunt placement (E & F, arrows).

Figure 2. MRI of the brain.

Figure 2

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Brain MRI showing a diffuse hyperintense signal on axial fluid-attenuated inversion recovery (FLAIR) (A) and axial T2-weighted images (B), which is consistent with high levels of protein and cholesterol. Sagittal (C) and coronal (D) sections of postcontrast T1-weighted images reveal no significant enhancement of the solid component. All these findings support the diagnosis of cystic craniopharyngioma. The lesion extended from anterior to posterior fossa and laterally to the middle fossa, compressing and elevating all basal elements (frontal lobes, temporal lobes, third ventricle, brain stem). The chronically compressed pituitary infundibulum has been elongated and pushed superiorly as shown (arrow in C).

A 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.

The 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 3). Follow-up MRIs showed no evidence of tumor regrowth or re-accumulation of cystic contents (Figure 4).

Figure 3. Immediate postoperative MRI.

Figure 3

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Sagittal (A) and coronal (B) postcontrast T1-weighted images showing complete evacuation of cystic contents, decompression of neurovascular elements, and no obvious solid tumor component.

Figure 4. Follow-up MRI at two years.

Figure 4

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Axial (A), sagittal (B), and coronal (C) postcontrast T1-weighted images revealing no re-accumulation of cystic contents. The elongated infundibulum of the pituitary gland is noted (arrow in B).

Discussion

In this paper, we report a child with a large CC, which was treated via NTVA only with no complications or recurrence after two years of follow-up. As there is a lack of consensus regarding the optimal surgical approach to manage CC, we conducted a literature review about the different treatment modalities and summarized our results in tables.

We found 17 reports that utilized the NTVA (with and without Ommaya reservoir insertion) for the treatment of CC in 67 patients, with a follow-up period ranging from six to 73 months; the recurrence rate ranged between nil to 54% (Table 1) [2-3,5-19].

Table 1. Summary of the literature reporting the neuroendoscopic transventricular approach in the management of cystic craniopharyngioma.

CSF, cerebrospinal fluid; mo., month(s); N, number of patients; NA, not available; NR, not reported; Pt(s): patient(s); yrs., years

Author(s) (year) N Age (yrs.) Characteristics Location Signs & Symptoms Surgical drainage Radiotherapy Follow-up (mo.) Recurrence Comments
Hellwig et al. (1995) [5] 5 NR Cystic; mixed NR NR Endoscopy (CSF) No NR No cyst recurrence 40% reported for the solid portion
Nakamizo et al. (2001) [6] 1 3 Cystic Third ventricle Gait disturbance; somnolence Endoscopy (CSF) No 24 No Nearly disappearing cystic tumor; no clinical meningitis or neurologic deficit
Joki et al. (2002) [7] 1 10 Cystic Sella, pons, & medulla oblongata Headache; visual acuity impairment Endoscopy (CSF) Yes 6 No Complete cystic decompression; visual acuity and headache improvement
Delitala et al. (2004) [8] 7 9–72 Cystic; recurrence (43%) Supradiaphragmatic; parachiasmatic; extraventricular (4 Pts); intra- + extraventricular (1 Pt); purely intraventricular (2 Pts) NR Endoscopy (CSF) 14% (pre) 38 28% No chemical meningitis
Nakahara et al. (2004) [3] 3 46–76 Cystic Suprasellar Headache; dementia; incontinence; hemianopsia Endoscopy (CSF) Yes 7 33% Decompression of the optic chiasm
Tirakotai et al. (2004) [9] 10 NR Mixed NR NR Endoscopy (CSF) No NR No cyst recurrences; 20% re-operated for solid portion None
Kamikawa & Inui (2005) [10] 1 4 Cystic Suprasellar Visual disturbance; headache Endoscopy (CSF) Yes NR NR No chemical ventriculitis or meningitis
Berlis et al. (2006) [11] 1 63 Cystic; recurrence NR Focal neurological deficits Endoscopy (CSF) No 6 No Evident decrease of cyst size
Cinalli et al. (2006) [12] 1 NA Cystic NA NA Endoscopy (CSF) No 12 No None
Fujimoto et al. (2007) [13] 1 74 Mixed Suprasellar region, extending cranially & obstructing the foramina of Monro bilaterally Headache; dizziness & gait disturbance Endoscopy (CSF) No 48 No Symptoms improved, except for hemianopsia; reduction of cyst size
Cappabianca et al. (2008) [14] 1 3 Cystic Intraventricular Headache; vomiting; bilateral papilledema Endoscopy (CSF) No 36 No None
Park et al. (2011) [15] 13 26 Cystic NR NR Endoscopy Yes 32 54% Ommaya reservoir kept in place postoperatively; visual fields stable or improved in 12 Pts (92.3%); preservation of endocrine function
Mohanty et al. (2013) [16] 3 44.6 (18–63) Solid (2 Pts); cystic (1 Pt) Intraventricular Headache; visual disturbance; drowsiness; memory impairment; confusion Endoscopy Yes (1 Pt) 11.6 No Weakness & memory impairment improved
Takano et al. (2015) [17] 9 56.7 (35–88) Cystic Sellar & suprasellar (2 Pts) Suprasellar (7 Pts) Raised intracranial pressure; headache; memory disturbance; visual disturbance; hypopituitarism Endoscopy (CSF) Yes 73 11% Tumor size reduction; symptoms improved
Shukla (2015) [18] 3 5–12 Cystic Small calcified suprasellar tumor; large cyst extending into the third ventricle Raised intracranial pressure Endoscopy (CSF) Yes 6–11 No Collapse of the cyst; subsidence of hydrocephalus
Moore et al. (2017) [19] 2 7 Cystic Suprasellar Headache; nausea; vomiting; somnolence; behavioral changes; decreased visual fields NR No 24 No None
Lauretti et al. (2018) [2] 8 43 (32–52) Cystic; mixed NR Raised intracranial pressure; hypothalamic or pituitary dysfunction; visual disturbances Endoscopy (CSF) 12.5% (pre) 56 12.5% None
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The surgical modality of choice may differ depending on patient- and/or tumor-related factors. In pediatric and adult patients with good functional status, long life expectancy, and small tumor size, microsurgical gross-total resection (GTR) is the recommended strategy [3]. GTR may be considered an acceptable option for tumors not invading the hypothalamus due to the low risk of recurrence and to avoid subsequent radiotherapy. Tumors invading the pituitary stalk, however, are potentially better managed with sub-total resection (STR) due to the high risk of postoperative endocrinopathy [18]. Tumor recurrence, reaching up to 62% (Table 2), is the main concern following microsurgery, endoscopic endonasal, and/or Ommaya reservoir insertion [15,17,20-60]. Alternatively, see Table 2 for the recurrence rate of CC managed with NTVA (without Ommaya reservoir insertion) ranged between 0% and 33% across various studies.

Table 2. Summary of the literature reporting microsurgical, endoscopic endonasal, and Ommaya reservoir procedures for patients with cystic craniopharyngioma.

GTR, gross-total resection; mo., month(s); N, number of patients; NA, not available; NR, not reported; NTR, near-total resection; PR, partial resection; Pt(s), patient(s); STR, sub-total resection; yrs., years

Author(s) (year) Surgical Approach Approach Details N Age (yrs.) Characteristics Postoperative Visual Function Follow-up (mo.) Recurrence
Yasargil (1996) [20] Microsurgery NA 162 NA NA NA NA 10%
Fahlbusch et al. (1999) [21] Microsurgery Among 148 primary Pts: GTR 73, STR 33, PR 21, Biopsy 4, No resection 17 Among 34 Pts with recurrence: GTR 12, STR 7, PR 15 Primary 148 (Adults 118 – Children 30); Secondary 20 Primary surgery: 36.6 (1 – 79)  Among 148 primary Pts: Purely cystic 5, Predominantly cystic 73, Predominantly solid 42, Purely solid 16, Multicystic 12; Among 34 Pts with recurrence: Purely cystic 1, Predominantly cystic 15, Predominantly solid 12, Purely solid 2, Multicystic 4 Primary Surgery: Normalized 38%, Improved 35%, Unchanged 14%, Worsened 12%; Surgery for recurrence: Normalized 12% Improved 48% Unchanged 32% Worsened 8% GTR (30 Pts) 120; STR (86 Pts) 60; Mean 64.8 GTR 19%; STR 52%
Van Effenterre & Boch (2002) [24] Microsurgery GTR 72; STR 35; PR 15 122 32.7 (1.5 – 78) NR Of 76 Pts followed: Normalized 34%; Improved 48%; Unchanged 3%; Worsened 14% Mean 84 24%
Im et al. (2003) [22] Microsurgery GTR 6 10.6 Cystic All improved Mean 23 16%
Karavitaki et al. (2005) [23] Microsurgery GTR 16 (Group A), GTR + Radiotherapy 3 (Group B), PR 51 (Group C), PR + Radiotherapy 33 (Group D), Cyst evacuation 6 (Group E), Cyst evacuation + Radiotherapy 3 (Group F) 121 Age <16: 42, Age ≥16: 79, Total: 2.5 – 83 Purely or predominantly cystic 42/91, Mixed 33/91, Purely or predominantly solid 16/91 Worsening of visual fields at 10 yrs.: Group A: 9%, Group B: 0%, Group C: 45%, Group D: 24% Mean 103 GTR 0%, PR 62%
Filis et al. (2009) [31] Microscopic-endoscopic GTR 1 7 Cystic NR 24 No
Schubert et al. (2009) [38] Microsurgery GTR 6, SR 11 17 ≤17 Cystic NR 66 58%
Ichikawa et al. (2016) [34] Microscopic-endoscopic GTR 4 6.4 Cystic Improved 2, Unchanged 2 Mean 142 25%
Feng et al. (2018) [30] Microsurgery GTR 124, STR 37, PR 13 183 36.2 (3 – 77) NR Improved 54, Worsened 22 27.3 12%
Shibata et al. (2018) [39] Microsurgery + Endoscopic endonasal GTR 1 1 Cystic Improved (light perception) 18 No
Abe et al. (1997) [25] Endoscopic endonasal GTR 15 STR 19 35 27 (8 – 72) Cystic Improved 18 Unchanged NR Worsened NR Mean 24.1 8.6%
Buhl et al. (2001) [26] Endoscopic endonasal NR 1 4 Cystic Improved 12 No
Fujimoto et al. (2002) [32] Endoscopic endonasal + Radiation therapy GTR 1 8 Cystic Improved 30 No
Locatelli et al. (2004) [36] Endoscopic endonasal GTR 1, Draining cyst contents to sphenoid sinus 3, Multiphase approach 1 5 2 – 16 Cystic NR Mean 48 20%
Chakrabarti et al. (2005) [28] Endoscopic endonasal GTR 61, PR 7 68 2.5 – 73 Cystic & solid Improved 54, Unchanged 12, Worsened 2 Mean ≥66 10%
Rudnick & DiNardo (2006) [37] Endoscopic endonasal - 1 31 Cystic NR 28 No
Gardner et al. (2008) [33] Endoscopic endonasal GTR 11, PR 5 16 55 (36 – 80) NR Improved 13, Unchanged 1, Worsened 0 Mean 34 11%
Stamm et al. (2008) [40] Endoscopic endonasal GTR 4, STR 3 7 23.4 NR Improved 2, Unchanged 1, Worsened 0 Mean 36.2 No
Fatemi et al. (2009) [29] Endoscopic endonasal GTR 3, NTR/STR 15 18 40 (18 – 62) NR Improved 11, Unchanged 1, Worsened 0, No impairment preop/postop 6 Mean 20 0% (among 16 Pts)
Campbell et al. (2010) [27] Endoscopic endonasal GTR 4, NTR 9 14 45 (18 – 65) NR Improved 12, Unchanged 1, Worsened 1 NR NR
Jane et al. (2010) [35] Endoscopic endonasal Radical 6, GTR 5, STR 1 12 50.77 (29 – 76) Mixed 8, Cystic 3, Solid 1 Improved 7, Unchanged 5, Worsened 0 Mean 13.3 NR
Coppens & Couldwell (2010) [44] Endoscopic endonasal STR 1 26 NR Improved 18 No
Garcia-Navarro et al. (2011) [46] Endoscopic endonasal GTR 2 NR NR NR NR NR
Leng et al. (2012) [49] Endoscopic endonasal GTR 21 24 43.6 (5 – 82) Cystic 10, Solid & cystic 14 Improved 10, Unchanged 3, Worsened 1 Mean 32.9 26%
Koutourousiou et al. (2013) [48] Endoscopic endonasal GTR 46, STR 14, PR 4 64 (Primary 47 – Recurrent 17) 40 (4 – 82) NR Improved 38, Unchanged 5, Worsened 1 Mean 38 34%
Cavallo et al. (2014) [43] Endoscopic endonasal GTR 71, STR 26, PR 6 103 42.5 (3 – 83) NR Improved 63, Unchanged 14, Worsened 2 Mean 48 22%.
Gu et al. (2015) [47] Endoscopic endonasal GTR 3 36.3 Solid Improved 3, Unchanged 0, Worsened 0 Mean 35.6 33%
Prabhu et al. (2015) [50] Endoscopic endonasal GTR 1 79 Cystic Improved NR NR
Abou-Al-Shaar et al. (2016) [41] Endoscopic endonasal GTR 1 22 Cystic & solid NR 12 No
Bal et al. (2016) [42] Endoscopic endonasal GTR 20 25 (Primary 15 – Recurrent 10) 5 – 68 NR Improved 15, Unchanged 10, Worsened 0 Mean 54.7 NR
Fomichev et al. (2016) [45] Endoscopic endonasal GTR 98 136 49.3 (13-73) NR Improved + Unchanged 121, Worsened 15 Mean 42 20%
Mangussi-Gomes et al. (2018) [54] Endoscopic endonasal NR 1 72 Cystic & solid NR NR NR
Locatelli et al. (2018) [53] Endoscopic endonasal NR 1 43 Cystic & solid Improved 12 No
Vitaz et al. (2001) [59] Ommaya reservoir NR 2 9 Cystic NR NR NR
Nicolato et al. (2004) [56] Ommaya reservoir endoscopy + bleomycin GTR 3, STR 4, PR 1 8 35.1 (12 – 74) Cystic Improved 5, Unchanged 2, Worsened 1 Mean 42.8 12.5%
Park et al. (2011) [15] Ommaya reservoir endoscopy STR 13 13 26.0 (4 – 66) Cystic Improved 12, Unchanged 0, Worsened 1 Mean 32 54%
Moussa et al. (2013) [55] Ommaya reservoir + Stereotaxy NR 52 6 – 42 Cystic Improved 21, Unchanged 17, Worsened 0 Mean 54 27%
Rahmathulla & Barnett (2013) [51] Ommaya reservoir + Stereotaxy STR 4 4 58 (31 – 78) Cystic Improved + Unchanged 4 Mean 55 No
Srikandarajah et al. (2014) [57] Ommaya reservoir NR 6 NR Cystic NR NR 33%
Takano et al. (2015) [17] Ommaya reservoir endoscopy NR 9 56.7 (35 –88) Cystic Improved 9 Mean 73 11%
Vakharia et al. (2017) [58] Ommaya reservoir NR 1 75 Cystic NR NR NR
Zhu et al. (2017) [60] Ommaya reservoir + Microsurgery GTR 8, STR 3 11 7.36 Cystic Improved + Unchanged 11 Mean 18.6 No
Lauretti et al. (2018) [2] Ommaya reservoir endoscopy NR 8 43 (32 – 52) Cystic & mixed Improved 8 Mean 56 12.5%
Frio et al. (2019) [52] Ommaya reservoir endoscopy (8 Pts) + Stereotaxy (3 Pts) NR 11 49.5 (18 – 77) Cystic Improved 5, Unchanged NR, Worsen NR Mean 41.4 27.3%
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The NTVA is recognized as a safe, efficacious, and minimally invasive procedure for intra- and paraventricular craniopharyngiomas, especially for cystic, large, and extensive lesions [2-3]. Our literature review results, as well as our experience exemplified by the case report described above, further support this notion (Table 1, Table 3). Intraoperative fenestration of the cyst wall usually drains the dense liquid content, typically described as ‘engine oil’ in color and texture [2]; spillage of the cyst contents into spaces containing cerebrospinal fluid (CSF) may lead to chemical meningitis and possibly secondary hydrocephalus [32]. Some authors advocate inserting a catheter with an Ommaya reservoir to allow for intermittent drainage, combined with radiation therapy [51]; long-term catheter placement, however, is associated with risks of infection, catheter displacement, content re-accumulation due to cyst septations, and pain with Ommaya reservoir tapping. Remarkably, none of the NTVA studies summarized in Table 1 reported the occurrence of chemical meningitis or delayed hydrocephalus secondary to the communication of CSF spaces with the cyst.

Table 3. Comparison of recurrence rates among different surgical modalities.

N, number of patients

Surgical Approach/Procedure N Recurrence rate
Neuroendoscopic transventricular without an Ommaya reservoir 37 0% to 33%
Endoscopy endonasal 540 0% to 34%
Microsurgical 785 0% to 62%
Ommaya reservoir insertion 125 0% to 54%
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The low complication and recurrence rates (Table 1 and Table 3) following NTVA, as well as the endoscopic endonasal approach, compared to microsurgery and Ommaya reservoir insertion, support the validity of these minimally invasive techniques as credible and potentially better alternatives in the management of CC or cystic-dominant craniopharyngiomas. This conclusion is limited by the small number of reported NTVA cases and the heterogeneity of the published studies.

Conclusions

The NTVA is efficient, reliable, and safe for managing CC and cystic-dominant craniopharyngiomas, with potentially lower recurrence and complication rates compared to microsurgery and Ommaya reservoir insertion. Future randomized clinical studies comparing the various treatment modalities of CC are needed to solidify these conclusions.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

Human Ethics

Consent was obtained or waived by all participants in this study

References

  • 1.Combined endoscopic and microsurgical removal of a giant cystic craniopharyngioma in a six-year-old boy. Gangemi M, Seneca V, Mariniello G, Colella G, Magro F. Clin Neurol Neurosurg. 2009;111:472–476. doi: 10.1016/j.clineuro.2009.01.002. [DOI] [PubMed] [Google Scholar]
  • 2.Neuroendoscopic treatment of cystic craniopharyngiomas: a case series with systematic review of the literature. Lauretti L, Legninda Sop FY, Pallini R, Fernandez E, D'Alessandris QG. World Neurosurg. 2018;110:0–73. doi: 10.1016/j.wneu.2017.11.004. [DOI] [PubMed] [Google Scholar]
  • 3.Neuroendoscopic transventricular surgery for suprasellar cystic mass lesions such as cystic craniopharyngioma and Rathke cleft cyst. Nakahara Y, Koga H, Maeda K, Takagi M, Tabuchi K. Neurol Med Chir (Tokyo) 2004;44:408–413. doi: 10.2176/nmc.44.408. [DOI] [PubMed] [Google Scholar]
  • 4.Endoscopic transventricular positioning of intracystic catheter for treatment of craniopharyngioma. Technical note. Pettorini BL, Tamburrini G, Massimi L, Caldarelli M, Di Rocco C. J Neurosurg Pediatr. 2009;4:245–248. doi: 10.3171/2009.4.PEDS0978. [DOI] [PubMed] [Google Scholar]
  • 5.Stereotactic endoscopic interventions in cystic brain lesions. Hellwig D, Bauer BL, List-Hellwig E. Acta Neurochir Suppl. 1995;64:59–63. doi: 10.1007/978-3-7091-9419-5_13. [DOI] [PubMed] [Google Scholar]
  • 6.Neuroendoscopic treatment of cystic craniopharyngioma in the third ventricle. Nakamizo A, Inamura T, Nishio S, Inoha S, Ishibashi H, Fukui M. Minim Invasive Neurosurg. 2001;44:85–87. doi: 10.1055/s-2001-16003. [DOI] [PubMed] [Google Scholar]
  • 7.Neuroendoscopic placement of Ommaya reservoir into a cystic craniopharyngioma. Joki T, Oi S, Babapour B, et al. Childs Nerv Syst. 2002;18:629–633. doi: 10.1007/s00381-002-0638-4. [DOI] [PubMed] [Google Scholar]
  • 8.Purely neuroendoscopic transventricular management of cystic craniopharyngiomas. Delitala A, Brunori A, Chiappetta F. Childs Nerv Syst. 2004;20:858–862. doi: 10.1007/s00381-004-0943-1. [DOI] [PubMed] [Google Scholar]
  • 9.Neuroendoscopic surgery of intracranial cysts in adults. Tirakotai W, Schulte DM, Bauer BL, Bertalanffy H, Hellwig D. Childs Nerv Syst. 2004;20:842–851. doi: 10.1007/s00381-004-0941-3. [DOI] [PubMed] [Google Scholar]
  • 10.Pediatric malignancies. Case 3. Craniopharyngioma in a 4-year-old girl: neuroendoscopic diagnosis and treatment. Kamikawa S, Inui A. J Clin Oncol. 2005;23:4793–4794. doi: 10.1200/JCO.2005.06.212. [DOI] [PubMed] [Google Scholar]
  • 11.Stent placement for intracranial cysts by combined stereotactic/endoscopic surgery. Berlis A, Vesper J, Ostertag C. Neurosurgery. 2006;59:0–80. doi: 10.1227/01.NEU.0000233694.52492.74. [DOI] [PubMed] [Google Scholar]
  • 12.The role of transventricular neuroendoscopy in the management of craniopharyngiomas: three patient reports and review of the literature. Cinalli G, Spennato P, Cianciulli E, Fiorillo A, Di Maio S, Maggi G. https://pubmed.ncbi.nlm.nih.gov/16700310/ J Pediatr Endocrinol Metab. 2006;19 Suppl 1:341–354. [PubMed] [Google Scholar]
  • 13.Neuroendoscopic palliation for large cystic craniopharyngioma in an elderly patient. Fujimoto Y, Fujimoto Y, Kato A, Yoshimine T. Br J Neurosurg. 2007;21:618–621. doi: 10.1080/02688690701630082. [DOI] [PubMed] [Google Scholar]
  • 14.Application of neuroendoscopy to intraventricular lesions. Cappabianca P, Cinalli G, Gangemi M, et al. Neurosurgery. 2008;62 Suppl 2:575–597. doi: 10.1227/01.neu.0000316262.74843.dd. [DOI] [PubMed] [Google Scholar]
  • 15.Recurrence rates after neuroendoscopic fenestration and Gamma Knife surgery in comparison with subtotal resection and Gamma Knife surgery for the treatment of cystic craniopharyngiomas. Park YS, Chang JH, Park YG, Kim DS. J Neurosurg. 2011;114:1360–1368. doi: 10.3171/2009.9.JNS09301. [DOI] [PubMed] [Google Scholar]
  • 16.Initial experience with endoscopic side cutting aspiration system in pure neuroendoscopic excision of large intraventricular tumors. Mohanty A, Thompson BJ, Patterson J. World Neurosurg. 2013;80:655–621. doi: 10.1016/j.wneu.2012.11.070. [DOI] [PubMed] [Google Scholar]
  • 17.Neuroendoscopy followed by radiotherapy in cystic craniopharyngiomas—a long-term follow-up. Takano S, Akutsu H, Mizumoto M, Yamamoto T, Tsuboi K, Matsumura A. World Neurosurg. 2015;84:1305–1315. doi: 10.1016/j.wneu.2015.06.022. [DOI] [PubMed] [Google Scholar]
  • 18.Transcortical transventricular endoscopic approach and Ommaya reservoir placement for cystic craniopharyngioma. Shukla D. Pediatr Neurosurg. 2015;50:291–294. doi: 10.1159/000433605. [DOI] [PubMed] [Google Scholar]
  • 19.Frontal burr hole approach for neuroendoscopic resection of craniopharyngioma with the NICO Myriad device: report of two cases. Moore RJ, Scherer A, Fulkerson DH. Childs Nerv Syst. 2017;33:659–664. doi: 10.1007/s00381-017-3386-1. [DOI] [PubMed] [Google Scholar]
  • 20.Yaşargil M. Stuttgart: Thieme Medical Publishers; 1996. Microneurosurgery. Microsurgery of CNS Tumors. [Google Scholar]
  • 21.Surgical treatment of craniopharyngiomas: experience with 168 patients. Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M. J Neurosurg. 1999;90:237–250. doi: 10.3171/jns.1999.90.2.0237. [DOI] [PubMed] [Google Scholar]
  • 22.Transsphenoidal microsurgery for pediatric craniopharyngioma: special considerations regarding indications and method. Im SH, Wang KC, Kim SK, Chung YN, Kim HS, Lee CH, Cho BK. Pediatr Neurosurg. 2003;39:97–103. doi: 10.1159/000071321. [DOI] [PubMed] [Google Scholar]
  • 23.Craniopharyngiomas in children and adults: systematic analysis of 121 cases with long-term follow-up. Karavitaki N, Brufani C, Warner JT, et al. Clin Endocrinol (Oxf) 2005;62:397–409. doi: 10.1111/j.1365-2265.2005.02231.x. [DOI] [PubMed] [Google Scholar]
  • 24.Craniopharyngioma in adults and children: a study of 122 surgical cases. Van Effenterre R, Boch AL. J Neurosurg. 2002;97:3–11. doi: 10.3171/jns.2002.97.1.0003. [DOI] [PubMed] [Google Scholar]
  • 25.Recent results of primary transnasal surgery for infradiaphragmatic craniopharyngioma. Abe T, Ludecke DK. Neurosurg Focus. 1997;3:0. doi: 10.3171/foc.1997.3.6.7. [DOI] [PubMed] [Google Scholar]
  • 26.Nasopharyngeal extension of a craniopharyngioma in a 4 year old girl. Buhl R, Nabavi A, Fritsch M, Mehdorn HM. Acta Neurochir (Wien) 2001;143:1283–1285. doi: 10.1007/s007010100026. [DOI] [PubMed] [Google Scholar]
  • 27.Endocrinological and ophthalmological consequences of an initial endonasal endoscopic approach for resection of craniopharyngiomas. Campbell PG, McGettigan B, Luginbuhl A, Yadla S, Rosen M, Evans JJ. Neurosurg Focus. 2010;28:0. doi: 10.3171/2010.1.FOCUS09292. [DOI] [PubMed] [Google Scholar]
  • 28.Long-term neurological, visual, and endocrine outcomes following transnasal resection of craniopharyngioma. Chakrabarti I, Amar AP, Couldwell W, Weiss MH. J Neurosurg. 2005;102:650–657. doi: 10.3171/jns.2005.102.4.0650. [DOI] [PubMed] [Google Scholar]
  • 29.Endonasal versus supraorbital keyhole removal of craniopharyngiomas and tuberculum sellae meningiomas. Fatemi N, Dusick JR, de Paiva Neto MA, Malkasian D, Kelly DF. Neurosurgery. 2009;64:269–284. doi: 10.1227/01.NEU.0000327857.22221.53. [DOI] [PubMed] [Google Scholar]
  • 30.Microsurgical treatment of craniopharyngioma. Experiences on 183 consecutive patients. Feng SY, Zhang YY, Yu XG, Chen XL, Zhou T, Bu B, Jiang JL. Medicine (Baltimore) 2018;97:0. doi: 10.1097/MD.0000000000011746. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Synchronous ventriculoscopic and microsurgical resection of complex craniopharyngiomas. Filis AK, Moon K, Cohen AR. Pediatr Neurosurg. 2009;45:434–436. doi: 10.1159/000277617. [DOI] [PubMed] [Google Scholar]
  • 32.Craniopharyngioma involving the infrasellar region. A case report and review of the literature. Fujimoto Y, Matsushita H, Velasco O, Rosemberg S, Plese JP, Marino R Jr. Pediatr Neurosurg. 2002;37:210–216. doi: 10.1159/000065396. [DOI] [PubMed] [Google Scholar]
  • 33.Outcomes following endoscopic, expanded endonasal resection of suprasellar craniopharyngiomas: a case series. Gardner PA, Kassam AB, Snyderman CH, Carrau RL, Mintz AH, Grahovac S, Stefko S. J Neurosurg. 2008;109:6–16. doi: 10.3171/JNS/2008/109/7/0006. [DOI] [PubMed] [Google Scholar]
  • 34.Hybrid microscopic-endoscopic surgery for craniopharyngioma in neurosurgical suite: technical notes. Ichikawa T, Otani Y, Ishida J, Fujii K, Kurozumi K, Ono S, Date I. World Neurosurg. 2016;85:340–348. doi: 10.1016/j.wneu.2015.08.058. [DOI] [PubMed] [Google Scholar]
  • 35.Early outcomes of endoscopic transsphenoidal surgery for adult craniopharyngiomas. Jane JA Jr, Kiehna E, Payne SC, Early SV, Laws ER Jr. Neurosurg Focus. 2010;28:0. doi: 10.3171/2010.1.FOCUS09319. [DOI] [PubMed] [Google Scholar]
  • 36.Endoscopic approach for the treatment of relapses in cystic craniopharyngiomas. Locatelli D, Levi D, Rampa F, Pezzotta S, Castelnuovo P. Childs Nerv Syst. 2004;20:863–867. doi: 10.1007/s00381-004-0944-0. [DOI] [PubMed] [Google Scholar]
  • 37.Image-guided endoscopic endonasal resection of a recurrent craniopharyngioma. Rudnick EF, DiNardo LJ. Am J Otolaryngol. 2006;27:266–267. doi: 10.1016/j.amjoto.2005.09.014. [DOI] [PubMed] [Google Scholar]
  • 38.Neurosurgical treatment strategies in childhood craniopharyngiomas: is less more? Schubert T, Trippel M, Tacke U, et al. Childs Nerv Syst. 2009;25:1419. doi: 10.1007/s00381-009-0978-4. [DOI] [PubMed] [Google Scholar]
  • 39.Urgent optic nerve decompression via an endoscopic endonasal transsphenoidal approach for craniopharyngioma in a 12-month-old infant: a case report. Shibata T, Tanikawa M, Sakata T, Mase M. Pediatr Neurosurg. 2018;53:182–187. doi: 10.1159/000487086. [DOI] [PubMed] [Google Scholar]
  • 40.Endoscopic transnasal craniotomy and the resection of craniopharyngioma. Stamm AC, Vellutini E, Harvey RJ, Nogeira JF Jr, Herman DR. Laryngoscope. 2008;118:1142–1148. doi: 10.1097/MLG.0b013e318170b5dc. [DOI] [PubMed] [Google Scholar]
  • 41.Expanded endonasal endoscopic approach for resection of an infrasellar craniopharyngioma. Abou-Al-Shaar H, Blitz AM, Rodriguez FJ, Ishii M, Gallia GL. World Neurosurg. 2016;95:618. doi: 10.1016/j.wneu.2016.08.044. [DOI] [PubMed] [Google Scholar]
  • 42.Endoscopic endonasal transsphenoidal surgery, a reliable method for treating primary and recurrent/residual craniopharyngiomas: nine years of experience. Bal E, Öge K, Berker M. World Neurosurg. 2016;94:375–385. doi: 10.1016/j.wneu.2016.07.004. [DOI] [PubMed] [Google Scholar]
  • 43.The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients. Cavallo LM, Frank G, Cappabianca P, et al. https://www.minervamedica.it/en/journals/neurosurgical-sciences/article.php?cod=R38Y2016N04A0454. J Neurosurg. 2014;121:100–113. doi: 10.3171/2014.3.JNS131521. [DOI] [PubMed] [Google Scholar]
  • 44.Staged use of the transsphenoidal approach to resect superior third ventricular craniopharyngiomas. Coppens JR, Couldwell WT. Minim Invasive Neurosurg. 2010;53:40–43. doi: 10.1055/s-0029-1246160. [DOI] [PubMed] [Google Scholar]
  • 45.Extended transsphenoidal endoscopic endonasal surgery of suprasellar craniopharyngiomas. Fomichev D, Kalinin P, Kutin M, Sharipov O. World Neurosurg. 2016;94:181–187. doi: 10.1016/j.wneu.2016.06.124. [DOI] [PubMed] [Google Scholar]
  • 46.Use of a side-cutting aspiration device for resection of tumors during endoscopic endonasal approaches. Garcia-Navarro V, Lancman G, Guerrero-Maldonado A, Anand VK, Schwartz TH. Neurosurg Focus. 2011;30:0. doi: 10.3171/2011.1.FOCUS10302. [DOI] [PubMed] [Google Scholar]
  • 47.Suprachiasmatic translamina terminalis corridor used in endoscopic endonasal approach for resecting third ventricular craniopharyngioma. Gu Y, Zhang X, Hu F, Yu Y, Xie T, Sun C, Li W. https://thejns.org/view/journals/j-neurosurg/122/5/article-p1166.xml. J Neurosurg. 2015;122:1165. doi: 10.3171/2015.1.JNS132842. [DOI] [PubMed] [Google Scholar]
  • 48.Endoscopic endonasal surgery for craniopharyngiomas: surgical outcome in 64 patients. Koutourousiou M, Gardner PA, Fernandez-Miranda JC, Tyler-Kabara EC, Wang EW, Snyderman CH. J Neurosurg. 2013;119:1194–1207. doi: 10.3171/2013.6.JNS122259. [DOI] [PubMed] [Google Scholar]
  • 49.Endoscopic, endonasal resection of craniopharyngiomas: analysis of outcome including extent of resection, cerebrospinal fluid leak, return to preoperative productivity, and body mass index. Leng LZ, Greenfield JP, Souweidane MM, Anand VK, Schwartz TH. Neurosurgery. 2012;70:110–123. doi: 10.1227/NEU.0b013e31822e8ffc. [DOI] [PubMed] [Google Scholar]
  • 50.Preservation of pituitary function after endonasal craniopharyngioma surgery: case report and review of the literature. Prabhu V, Anand VK, Schwartz TH. Cureus. 2015;7:0. doi: 10.7759/cureus.305. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51.Minimally invasive management of adult craniopharyngiomas: an analysis of our series and review of literature. Rahmathulla G, Barnett GH. Surg Neurol Int. 2013;4:0–21. doi: 10.4103/2152-7806.121612. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 52.Ommaya reservoir system for the treatment of cystic craniopharyngiomas: surgical results in a series of 11 adult patients and review of the literature. Frio F, Solari D, Cavallo LM, Cappabianca P, Raverot G, Jouanneau E. World Neurosurg. 2019;132:0–77. doi: 10.1016/j.wneu.2019.07.217. [DOI] [PubMed] [Google Scholar]
  • 53.Extended endoscopic endonasal approach for suprasellar craniopharyngioma. Locatelli D, Pozzi F, Agresta G, Padovan S, Karligkiotis A, Castelnuovo P. J Neurol Surg B Skull Base. 2018;79:0–8. doi: 10.1055/s-0038-1623529. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 54.Endoscopic endonasal transplanum transtuberculum approach for the resection of a large suprasellar craniopharyngioma. Mangussi-Gomes J, Vellutini EA, Truong HQ, Pahl FH, Stamm AC. J Neurol Surg B Skull Base. 2018;79:0–50. doi: 10.1055/s-0038-1625940. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 55.Surprising outcome of ommaya reservoir in treating cystic craniopharyngioma: a retrospective study. Moussa AH, Kerasha AA, Mahmoud ME. Br J Neurosurg. 2013;27:370–373. doi: 10.3109/02688697.2012.741732. [DOI] [PubMed] [Google Scholar]
  • 56.Multimodality stereotactic approach to the treatment of cystic craniopharyngiomas. Nicolato A, Foroni R, Rosta L, Gerosa M, Bricolo A. Minim Invasive Neurosurg. 2004;47:32–40. doi: 10.1055/s-2003-812467. [DOI] [PubMed] [Google Scholar]
  • 57.Indications for intracranial reservoirs: a six-year study. Srikandarajah N, Patel A, Lee MK, Brodbelt A. Br J Neurosurg. 2014;28:475–477. doi: 10.3109/02688697.2013.854314. [DOI] [PubMed] [Google Scholar]
  • 58.Spontaneous intraventricular rupture of a craniopharyngioma cyst: a case report. Vakharia K, Siasios ID, Dorsch AB, Leonardo J. Int J Crit Illn Inj Sci. 2017;7:126–128. doi: 10.4103/IJCIIS.IJCIIS_121_16. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 59.Changes in cyst volume following intraoperative MRI-guided Ommaya reservoir placement for cystic craniopharyngioma. Vitaz TW, Hushek S, Shields CB, Moriarty T. Pediatr Neurosurg. 2001;35:230–234. doi: 10.1159/000050427. [DOI] [PubMed] [Google Scholar]
  • 60.A reformed surgical treatment modality for children with giant cystic craniopharyngioma. Zhu W, Li X, He J, Sun T, Li C, Gong J. Childs Nerv Syst. 2017;33:1491–1500. doi: 10.1007/s00381-017-3473-3. [DOI] [PubMed] [Google Scholar]

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