Extended endoscopic transsphenoidal surgery with total cyst wall decollement for suprasellar cystic craniopharyngioma

Abstract

Abstract Background: For most cystic craniopharyngiomas, intracapsular debulking is a good strategy to get a large operation space and protect vital structures. However, this surgical strategy may lead to the residual and recurrence of the tumor capsule wall. Therefore, there is an urgent need for a new surgical strategy without residual capsule walls for the removal of cystic craniopharyngiomas.Case Report: We reviewed a 45-year-old male with vision loss and visual field defects, whose head MRI revealed a suprasellar cystic lesion. The patient underwent extended endoscopic transsphenoidal surgery. The surgical strategy of total cystic wall decollement was adopted, which was that the lesion surrounded by the capsule was completely separated from the surrounding tissue without destroying the capsule and maintaining the tension of the capsule. The lesion was totally resected and pathological findings confirmed the diagnosis of craniopharyngioma. After the operation, both the visual acuity and pituitary function were significantly improved. In addition, he suffered from transient diabetes insipidus, which was subsequently relieved. During the 33-month follow-up, there was no tumor recurrence. Conclusion: Compared with the traditional surgical strategy of intracapsular debulking, the surgical strategy of total cystic wall decollement has the advantages of less residual tumor capsule, low tumor recurrence rate, etc. Therefore, for cystic craniopharyngiomas with an intact capsule or even other cystic tumors with an intact capsule, the surgical strategy of total cystic wall decollement may be an effective surgical strategy to reduce tumor recurrence.