Advertisement

Management of Patient with Craniopharyngioma

  • M. Srilata
Chapter
  • 28 Downloads

Abstract

A 30-year-old female presented with one episode of seizures 2 months back, increased thirst, increased frequency of micturition and blurring of vision for the last 2 months and headache for last 2–3 years. On further evaluation, the patient had stunted growth with short stature, malnourished, primary amenorrhoea and absence of secondary sexual characters. On general examination, height was 136 cm, weight 18 kg and BMI 18 kg/m2. Her baseline vitals were as noted: HR—73/min, BP—87/45 mmHg and SPO2—100%. Routine investigations were within normal limits. Endocrine testing revealed serum FSH—0.7 mIU/mL, serum LH—0.1 mIU/mL, prolactin—5.4 ng/mL, GH—0.71 ng/mL, ACTH—39.8 pg/mL, IGF1—<15 ng/mL, serum cortisol—7.6 mcg/dL, serum osmolality—274 mOsm/L, urine osmolality—260 mOsm/L and glycosylated Hb—4.8%. Thyroid profile demonstrated serum total T3—1.4 nmol/L, serum total T4—11.9 mcg/dL, TSH—0.4 mcIU/mL, free T4—1.73 ng/dL and free T3—2.77 pg/mL (after 1 month of thyronorm 50 mcg dose daily). Visual field testing revealed bilateral temporal scotomas. CT brain showed signs of well-defined hypodense lesion in the suprasellar region with multiple peripheral calcification. MRI brain showed well-defined T1 hypointense, T2 flair hyperintense cystic lesion 6 × 3 × 2.8 cm in the suprasellar region extending superiorly into third and fourth ventricles; on contrast—heterogeneous enhancement of cyst wall was seen (Fig. 8.1). Medical management included tab thyronorm 50 mcg OD and tab levetiracetum 500 mg BD. The patient underwent craniotomy and decompression with aspiration of the cystic lesion, and an Ommaya reservoir with a catheter was placed inside the cyst cavity and left. The intraoperative and the immediate postoperative period was uneventful. And there was subjective improvement in the vision in the left eye. In the first and second PO days, she had hypernatremia which was managed with free water administration and monitoring of fluid intake and output. After 14 days of surgery, the patient developed nausea and vomiting with S&S of diabetes insipidus (DI) which was medically managed and deteriorating consciousness (MRI scan showed residual craniopharyngioma with mass effect with ventriculomegaly and Ommaya reservoir in situ) managed with ventriculoperitoneal shunt. Later both Glasgow coma scale (GCS) and DI improved.

References

  1. 1.
    Lania A, Spada A, Lasio G. Diagnosis and management of craniopharyngiomas: key current topics. Springer International Publishing; 2016.Google Scholar
  2. 2.
    Evans JJ, Kenning TJ. Craniopharyngiomas: comprehensive diagnosis, treatment and outcome. Elsevier Science; 2014.Google Scholar
  3. 3.
    Zoicas F, Schöfl C. Craniopharyngioma in adults. Front Endocrinol. 2012;3:46.CrossRefGoogle Scholar
  4. 4.
    Nelson GA, Bastian FO, Schlitt M, White RL. Malignant transformation in craniopharyngioma. Neurosurgery. 1988;22(2):427–9. PubMed PMID: 3352897.CrossRefGoogle Scholar
  5. 5.
    Wills MR, Havard B. Laboratory investigation of endocrine disorders. Elsevier Science; 2013.Google Scholar
  6. 6.
    Curran JG, O’Connor E. Imaging of craniopharyngioma. Childs Nerv Syst. 2005;21(8–9):635–9.CrossRefGoogle Scholar
  7. 7.
    Defoort-Dhellemmes S, Moritz F, Bouacha I, Vinchon M. Craniopharyngioma: ophthalmological aspects at diagnosis. J Pediatr Endocrinol Metab. 2006;19:321–4.PubMedGoogle Scholar
  8. 8.
    Barkhoudarian G, Laws ER. Craniopharyngioma: history. Pituitary. 2013;16(1):1–8.CrossRefGoogle Scholar
  9. 9.
    Müller HL. Craniopharyngioma. Endocr Rev. 2014;35(3):513–43.CrossRefGoogle Scholar
  10. 10.
    Bunin GR, Surawicz TS, Witman PA, Preston-Martin S, Davis F, Bruner JM. The descriptive epidemiology of craniopharyngioma. J Neurosurg. 1998;89(4):547–51.CrossRefGoogle Scholar
  11. 11.
    Kageji T, Miyamoto T, Kotani Y, Kaji T, Bando Y, Mizobuchi Y, et al. Congenital craniopharyngioma treated by radical surgery: case report and review of the literature. Childs Nerv Syst. 2017;33(2):357–62.CrossRefGoogle Scholar
  12. 12.
    ElSayed SA, Bhimji SS. Physiology, pituitary gland. StatPearls [Internet]: StatPearls Publishing; 2018.Google Scholar
  13. 13.
    Amar AP, Weiss MH. Pituitary anatomy and physiology. Neurosurg Clin. 2003;14(1):11–23.CrossRefGoogle Scholar
  14. 14.
    Fernandez-Miranda JC, Gardner PA, Snyderman CH, Devaney KO, Strojan P, Suárez C, et al. Craniopharyngioma: a pathologic, clinical, and surgical review. Head Neck. 2012;34(7):1036–44.CrossRefGoogle Scholar
  15. 15.
    Pekmezci M, Louie J, Gupta N, Bloomer MM, Tihan T. Clinicopathological characteristics of adamantinomatous and papillary craniopharyngiomas: University of California, San Francisco experience 1985–2005. Neurosurgery. 2010;67(5):1341–9.CrossRefGoogle Scholar
  16. 16.
    Müller HL. Preoperative staging in childhood craniopharyngioma: standardization as a first step towards improved outcome. Springer; 2016.Google Scholar
  17. 17.
    Bhatoe HS. Evolution of concepts in the management of craniopharyngiomas: lessons learnt from Prof. SN Bhagwati’s article published in 1993. Neurol India. 2018;66(3):613.CrossRefGoogle Scholar
  18. 18.
    Varlotto J, DiMaio C, Grassberger C, Tangel M, Mackley H, Pavelic M, et al. Multi-modality management of craniopharyngioma: a review of various treatments and their outcomes. Neuro-Oncol Pract. 2015;3(3):173–87.CrossRefGoogle Scholar
  19. 19.
    Bajwa SJS, Kaur G. Endocrinopathies: the current and changing perspectives in anesthesia practice. Indian J Endocrinol Metab. 2015;19(4):462.CrossRefGoogle Scholar
  20. 20.
    Mishra G, Chandrashekhar SR. Management of diabetes insipidus in children. Indian J Endocrinol Metab. 2011;15(Suppl3):S180.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Vinchon M, Weill J, Delestret I, Dhellemmes P. Craniopharyngioma and hypothalamic obesity in children. Childs Nerv Syst. 2009;25(3):347.CrossRefGoogle Scholar
  22. 22.
    Tomita T, Bowman RM. Craniopharyngiomas in children: surgical experience at Children’s Memorial Hospital. Childs Nerv Syst. 2005;21(8–9):729–46.CrossRefGoogle Scholar
  23. 23.
    Vinken PJ, Bruyn GW. Handbook of clinical neurology. Elsevier; 2002.Google Scholar
  24. 24.
    Rath GP, Dash HH. Anaesthesia for neurosurgical procedures in paediatric patients. Indian J Anaesth. 2012;56(5):502.CrossRefGoogle Scholar
  25. 25.
    Furay C, Howell T. Paediatric neuroanaesthesia. Contin Educ Anaesth Crit Care Pain. 2010;10(6):172–6.CrossRefGoogle Scholar
  26. 26.
    Sands SA, Milner JS, Goldberg J, Mukhi V, Moliterno JA, Maxfield C, et al. Quality of life and behavioral follow-up study of pediatric survivors of craniopharyngioma. J Neurosurg Pediatr. 2005;103(4):302–11.CrossRefGoogle Scholar
  27. 27.
    Prabhakar H. Paediatric neuroanaesthesia: Oxford University Press; 2018.Google Scholar
  28. 28.
    Cottrell JE, Young WL. Cottrell and Young’s neuroanesthesia. Elsevier Health Sciences; 2016.Google Scholar
  29. 29.
    Prabhakar H. Essentials of neuroanesthesia. Elsevier Science; 2017.Google Scholar
  30. 30.
    To E, Tsang W, Yiu F, Chan M. A missing throat pack. Anaesthesia. 2001;56(4):383–4.CrossRefGoogle Scholar
  31. 31.
    Bhaskar B, Fraser JF. Negative pressure pulmonary edema revisited: pathophysiology and review of management. Saudi J Anaesth. 2011;5(3):308.CrossRefGoogle Scholar
  32. 32.
    Tommasino C, Picozzi V. Volume and electrolyte management. Best Pract Res Clin Anaesthesiol. 2007;21(4):497–516. PubMed PMID: 18286834.CrossRefGoogle Scholar
  33. 33.
    Wise-Faberowski L, Soriano SG, Ferrari L, McManus ML, Wolfsdorf JI, Majzoub J, et al. Perioperative management of diabetes insipidus in children. J Neurosurg Anesthesiol. 2004;16(1):14–9. PubMed PMID: 00008506-200401000-00004.CrossRefGoogle Scholar
  34. 34.
    Cohen M, Bartels U, Branson H, Kulkarni AV, Hamilton J. Trends in treatment and outcomes of pediatric craniopharyngioma, 1975-2011. Neuro Oncol. 2013;15(6):767–74. PubMed PMID: 23486689.CrossRefGoogle Scholar
  35. 35.
    Iizuka O, Suzuki K, Mori E. Severe amnesic syndrome and collecting behavior after surgery for craniopharyngioma. Cogn Behav Neurol. 2007;20(2):126–30. PubMed PMID: 17558257.CrossRefGoogle Scholar
  36. 36.
    Grover WD, Rorke LB. Invasive craniopharyngioma. J Neurol Neurosurg Psychiatry. 1968;31(6):580–2. PubMed PMID: 5709844.CrossRefGoogle Scholar
  37. 37.
    Jane JA Jr, Prevedello DM, Alden TD, Laws ER Jr. The transsphenoidal resection of pediatric craniopharyngiomas: a case series. J Neurosurg Pediatr. 2010;5(1):49–60. PubMed PMID: 20043736.CrossRefGoogle Scholar
  38. 38.
    Coté CJ, Lerman J, Anderson BJ. A practice of anesthesia for infants and children: expert consult. Online and Print: Elsevier/Saunders; 2013.Google Scholar
  39. 39.
    Muller HL. Childhood craniopharyngioma: current controversies on management in diagnostics, treatment and follow-up. Expert Rev Neurother. 2010;10(4):515–24. PubMed PMID: 20367205.CrossRefGoogle Scholar
  40. 40.
    Sands SA, Milner JS, Goldberg J, Mukhi V, Moliterno JA, Maxfield C, et al. Quality of life and behavioral follow-up study of pediatric survivors of craniopharyngioma. J Neurosurg. 2005;103(4 Suppl):302–11. PubMed PMID: 16270681.PubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • M. Srilata
    • 1
  1. 1.Department of Anesthesia and Intensive CareNizams Institute of Medical SciencesHyderabadIndia

Personalised recommendations