Management of Patient with Craniopharyngioma

  • M. Srilata


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.


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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

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