1 - Pediatric Neurosurgery Unit, Hospital Dona Estefânia, Hospitalar Universitário de Lisboa Central
2 - Neurosurgery Department, Hospitalar Universitário de Lisboa Central
3 - Neuroradiology Department, Hospital São José, Hospitalar Universitário de Lisboa Central
4 - Pediatric Neuroradiology Unit, Hospital Dona Estefânia, Hospitalar Universitário de Lisboa Central
5 - Pathology Department, Hospitalar Universitário de Lisboa Central
- 26th biennal congress of the European Society for Pediatric Neurosurgery
Resumo:
Introduction: Craniopharyngioma metastasis is a rare condition with few reports in literature. Some of previously reported cases divides craniopharyngioma metastasis as primary or secondary to surgical procedures. Dumbbell shaped are also rare subtypes of craniopharyngioma and, in many cases, with such configuration that need to be planned in a staged manner in order to safely removal.
Material and Methods: The authors describe the case of an eight years old boy previously treated to remove a dumbbell shaped craniopharyngioma that showed a new lesion out from its original tumor site but correlated with previous surgical corridor. They describe the case and review literature
Results: An eight years old boy with a rare dumbbell shaped craniopharyngioma was surgically treated in a staged manner due to tumor configuration as it grew from sella turcica to fill the III ventricle coming between ACoA and chiasm through lamina terminalis. The authors performed a three steps surgery: an anterior transcallosal, right supraorbital/ subfrontal and endoscopic transnasal transsphenoidal approaches, with a gross total removal. Few months after MRI studies showed no tumor relapse but a new lesion at the right lesser sphenoid wing. Differential diagnosis were brain abscess, granuloma and seeded craniopharyngioma. As this lesion grew with time the authors decided to re-operate, performed a supraorbital/subfrontal approach to remove it and confirm a seeded craniopharyngioma with no relation with previous tumor site. After 4 years of follow up no relapse or new lesion could be seen in repeated MRI studies. The authors show pre- and postoperative MRI, surgical planning, surgical videos and histological images.
Discussion: There are few reports of craniopharyngioma metastasis or “seeded tumor”. As the authors show it might not be related with malignant behavior but as cellular seeding during surgical approaches that may keep in mind when imaging follow-up studies show new lesions in a previous surgical corridor.
Palavras Chave: craniofaringioma, seeded tumor, metastases