Neuroendoscopic Trans-ventricular Cyst Drainage Prior to Tumour Resection Using a Two-Staged Approach for Cystic...

Craniopharyngiomas are benign suprasellar tumours that can present with symptoms of raised intracranial pressure, visual impairment, or endocrine dysfunction. They are classified into the more common adamantinomatous and less common papillary tumours. Cystic variants may cause obstructive hydrocephalus, necessitating urgent intervention. This video case-based review presents the case of a 61-year-old male who presented with a two-month history of headaches, cognitive decline, and visual changes. Imaging revealed a large 2.8 x 2.2 x 2.2 cm suprasellar mass with cystic components extending into the third ventricle - consistent with a craniopharyngioma, causing bilateral foraminal obstruction and acute hydrocephalus. An urgent right frontal endoscopic septum pellucidostomy, cyst drainage, and ventriculoperitoneal shunt insertion achieved rapid symptomatic relief. Histopathology confirmed a World Health Organization (WHO) Grade 1 adamantinomatous craniopharyngioma. Following neurological stabilisation, a planned second-stage extended transsphenoidal resection achieved near-total removal. Postoperative radiotherapy was delivered to the tumour residuum. Endocrine sequelae, including hypopituitarism and diabetes insipidus, were managed with hormone replacement. At one-year follow-up, the patient remained radiologically stable with no recurrence. A review of current literature further supports neuroendoscopic transventricular cyst aspiration as a temporising measure in cyst-dominant craniopharyngiomas, particularly in the setting of acute hydrocephalus. This strategy offers rapid decompression, symptom relief, facilitating safer, elective definitive surgery. However, as a sole intervention, it is rarely curative, and recurrence risk remains high without subsequent resection and/or radiotherapy. A planned, two-stage approach combining neuroendoscopic decompression with definitive tumour control represents a safe and effective management strategy for giant cystic craniopharyngiomas.