Treatment of giant cystic craniopharyngiomas

We report two patients with giant cystic craniopharyngiomas approached transsphenoidally, with continuous cyst drainage through a silastic tube, connecting the cyst with the sphenoid sinus. An innovative technique for fixation of the tube and reconstruction of the sphenoid sinus is presented which consists of the use of a combination of silk, resin and calcium carbonate. Postoperatively, although both patients developed diabetes insipidus, both patients improved neurologically. At follow-up examinations (32 and 48 months), neither patient had migration of the silastic tube, evidence of meningitis, nor cerebrospinal fluid leak. We propose this technique as a surgical alternative for large cystic craniopharyngiomas on which attempt of total resection carries a high risk of severe neurological complications.