Authors: Kathrin Schmalisch Rudi Beschorner Tsambika Psaras Juergen Honegger
Publish Date: 2009/10/27
Volume: 152, Issue: 2, Pages: 313-319
Abstract
The first patient was a 13yearold boy who had initially undergone radical excision of a suprasellar and retrosellar craniopharyngioma by a right pterional approach Postoperative MRI showed no evidence of residual tumor Two years later MRI revealed a local recurrence and in addition a separated cystic tumor on the right side adjacent to the middle cerebral artery consistent with seeding along the surgical route Both tumors were removed by reoperation On histopathological examination both the local recurrent tumor and the distant deposit turned out to be adamantinomatous craniopharyngiomas The second patient was a 27yearold woman who was operated on for the first time via a right pterional and 1 year later for a recurrent craniopharyngioma via a transsphenoidal approach Two years later MRI revealed a right frontolateral intracranial metastasis at the site of the former craniotomy which was removed by recraniotomy This deposit in the operative pathway was found to be an adamantinomatous craniopharyngioma as was the initial tumor The third patient was a 42yearold man who was operated on 10 years ago for the first time via a right frontotemporal approach The recent control MRT revealed a right parietal intracranial tumor with peripheral contrast enhancement which was located distant to the former craniotomy The tumor was removed and histopathological examination revealed an adamantinomatous craniopharyngioma in accordance with the initial tumor Postoperatively the three patients were neurologically intactAlthough craniopharyngiomas exhibit a benign histopathological pattern cerebrospinal fluid seeding along the surgical route or along the CSF pathways has been observed Ectopic recurrence of craniopharyngioma suggests that meticulous protection of the whole surgical field and careful handling of the tumor during the operation are required It should be emphasized that longterm followup is mandatory even in patients undergoing a total removal
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