craniopharyngioma endoscopy
TRANSCRIPT
Transcortical Transventricular Endoscopic Approach and
Ommaya Reservoir Placement for Cystic Craniopharyngioma
Dhaval ShuklaDepartment of Neurosurgery, NIMHANS, Bangalore, India.
Cystic Craniopharyngiomas
• Cyst accounts for major tumor bulk • Complete resection of cystic craniopharyngiomas is
desirable • Hindered by functional preservation
• Regrow after partial resection or cyst puncture• Ommaya reservoir for repeated aspiration
• Reservoir is generally placed after partial surgical resection, or stereotactically
• Malposition of reservoir is not uncommon• A simple technique of endoscopic approach and
reservoir placement for cystic craniopharyngiomasMori RJ, et al. J Neurol Surg A. 2014.
Pettorini BL, et al. J Neurosurg Pediatr. 2009.
Video
https://www.youtube.com/watch?v=DnBTEjO_RNs
Data
• Five Cases – 3 children• Presented with raised ICP, no endocrinopathy• Purely or predominantly cystic tumors• Post op RT• F/u – 12 -17 months • No recurrence• No reaspiration• No dislodgement of catheter• No adverse effect related to procedure
Treatment Paradigm
• Traditional algorithms (gross total resection vs. subtotal resection +/- radiation therapy) are often not employed• Alternative algorithms including intracystic therapies,
progression-contingent RT, and SRS
• Survey of members of AANS • 36% recommended observation or RT for in absence of
diagnosis
• This change in treatment paradigm calls for minimally invasive technique for treatment • Innovative treatment strategies are warranted to
improve QoL
Hankinson TC, et al. Pediatr Neurosurg. 2013.Muller HL. Horm Res. 2008.
Why Reservoir?
• Our previous series • 52.5% partial excision• Complication rate 19.1%• GTR - 29.2% • PR - 10.4% • Pediatric 35.7% • Adult 4.3%
• PR preferred but recurrence is high• Repeated aspiration • Injection of chemotherapeutic agents
Patel A. NIMHANS 2005.
Why Endoscopy?
• Improper placement of the catheter with other techniques• 7% to 16%
• Endoscopy results in accurate catheter placement• Biopsy under direct vision can be done• Hydrocephalus can be take care of• Not associated with any morbidity
• Early RT after surgery can be given
• Another procedure may not be required• 73% did not require reaspiration
Mori RJ, et al. J Neurol Surg A. 2014.Moussa AH, et al. Br J Neurosurg. 2013
Limitations
• Large defect in cyst wall can predispose to leakage if intracystic therapies are employed• 16.3% children had misplacement or leakage of the
catheter (not endoscopic)
• Can be difficult in case of multiloculated cystic • Possible to fenestrate multiple loculation, and convert
all of them into a single cyst
• Excision cannot be done• Not a goal of this procedure
Zanon N, et al. Surg Neurol. 2008.Pettorini BL, J Neurosurg Pediatr. 2009.
Conclusion
Transcortical transventricular endoscopic approach and
Ommaya reservoir placement for cystic craniopharyngioma
is a minimally invasive, safe, accurate, and effective method.
Shukla D. Transcortical Transventricular Endoscopic Approach and Ommaya
Reservoir Placement for Cystic Craniopharyngioma.
Pediatric Neurosurgery 2015. DOI: 10.1159/000433605