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Sella Bugged! Abscess Inside a Craniopharyngioma: Case Report with Literature Review
Gaurav Tyagi1, Santhosh Kumar S A2, Sandeep Kandregula3
1Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India, dr_gauravtyagi@yahoo.com.
Insights
This report details the first pediatric case of a craniopharyngioma (CPG) with abscess. Management involved controlled pus drainage, partial resection, antibiotics, and radiation, leading to positive outcomes.
Area of Science:
- Pediatric Neurosurgery
- Neuro-oncology
- Infectious Diseases
Background:
- Abscess within craniopharyngioma (CPG) is exceptionally rare, with only 8 prior cases reported.
- CPG typically presents with hypopituitarism and visual disturbances.
Observation:
- A 10-year-old girl presented with visual deterioration and bitemporal hemianopia, suggestive of a sellar-suprasellar CPG.
- A transcranial approach revealed a thick-walled, inflamed lesion from which purulent material was drained.
- Histopathology confirmed adamantinomatous CPG, with abscess culture positive for Enterococcus species.
Findings:
- This is the first documented pediatric case of a craniopharyngioma with a secondary abscess.
- Successful management included controlled abscess drainage, partial tumor resection, culture-specific antibiotics, and radiotherapy.
- The patient showed significant clinical and radiological improvement at 1-year follow-up.
Implications:
- Highlights the importance of addressing infection as a distinct entity in CPG management.
- Controlled drainage and partial resection followed by adjuvant therapy are effective when complete resection is not feasible.
- Emphasizes a multidisciplinary approach for managing complex pediatric CPG cases with abscess.
Introduction:
Abscess within a craniopharyngioma (CPG) is extremely rare and only 8 such cases have been reported in literature. Most patients present with hypopituitarism and visual disturbances. We report the first ever case of a CPG with abscess in a pediatric patient.
Case Report:
A 10-year-old girl presented with visual deterioration and bitemporal hemianopia. Her CT and MRI brain suggested of a sellar-suprasellar CPG. Due to ill-developed sino-nasal anatomy, a transcranial approach was made for the lesion. The lesion was well capsulated, thick walled, and appeared inflamed. Upon incising the wall, thick yellowish pus was drained out in a controlled manner. This was followed by a partial resection of the CPG wall and eccentric, adhered, calcified residue was left behind with an Ommaya drain. The abscess culture grew Enterococcus species and histopathology revealed adamantinomatous CPG. Patient underwent culture sensitive antibiotics course followed by radiation for the residue. She was doing well at 1-year follow-up with clinical and radiological improvement.
Conclusion:
This is the first report of a pediatric case with secondary abscess in CPG. Operative management of such a case includes controlled drainage of pus without dissemination into the surrounding arachnoid space. The tumor and abscess have to be addressed as separate surgical entities; infection control and wherever complete resection is not feasible, partial safe resection followed by radiotherapy is a viable option.
