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Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Craniopharyngiomas with intratumoral hemorrhage--two case reports
Shiro Yamashita1, Yoshihito Matsumoto, Katsuzo Kunishio
1Department of Neurological Surgery, Kagawa University, Kagawa, Japan.
Abstract:
Two cases of craniopharyngioma with intratumoral hemorrhage are reported. A 22-year-old male was admitted with meningitis. Lumbar tapping was performed twice. He subsequently developed reduced visual acuity and field deterioration due to intratumoral hemorrhage from an intra- and suprasellar tumor. He underwent emergency craniotomy and total extirpation of the tumor. A 29-year-old female underwent partial extirpation of an intra- and suprasellar cystic tumor via transsphenoidal surgery. Two months after the first operation, she suffered intratumoral hemorrhage necessitating emergency surgery and subsequent gamma-knife therapy. The histological diagnosis was craniopharyngioma in both cases. Hemorrhage is extremely rare in craniopharyngiomas and difficult to discriminate from that in pituitary adenoma, but both diseases require decompression by clot extirpation.
Insights
Intratumoral hemorrhage is a rare complication of craniopharyngioma, a type of brain tumor. Prompt surgical intervention is crucial for managing this rare event and preventing further neurological damage.
Area of Science:
- Neuro-oncology
- Neurosurgery
- Endocrinology
Background:
- Craniopharyngiomas are rare tumors arising from remnants of Rathke's pouch, typically located in the sellar and suprasellar regions.
- Intratumoral hemorrhage is an uncommon but potentially devastating complication of craniopharyngiomas.
- Distinguishing hemorrhage in craniopharyngiomas from that in pituitary adenomas is clinically important due to shared anatomical locations.
Observation:
- Two cases of craniopharyngioma presenting with intratumoral hemorrhage are detailed.
- Case 1: A 22-year-old male with meningitis developed visual decline due to hemorrhage in an intra- and suprasellar craniopharyngioma, treated with emergency craniotomy.
- Case 2: A 29-year-old female experienced hemorrhage in a cystic intra- and suprasellar craniopharyngioma post-surgery, requiring further intervention including gamma-knife therapy.
Findings:
- Histological diagnosis confirmed craniopharyngioma in both patients.
- Intratumoral hemorrhage in craniopharyngiomas is exceptionally rare.
- Effective management necessitates prompt clot extirpation for tumor decompression.
Implications:
- Hemorrhage in craniopharyngiomas, though rare, requires urgent surgical decompression.
- Early recognition and management are vital to prevent irreversible visual deficits and neurological compromise.
- These cases highlight the importance of considering hemorrhage in the differential diagnosis of sellar/suprasellar masses, even in the context of craniopharyngioma.
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