Conservative surgical approach and early postoperative radiotherapy in a patient with a huge cystic craniopharyngioma

Objective: The treatment of huge craniopharyngiomas represents a therapeutic challenge for neurosurgeons. Some authors prefer to run the high risks of total removal at primary surgery, while others do not despise subtotal removal in accordance with a multidisciplinary treatment. Methods: We report the case of a 17-year-old girl who underwent subtotal removal (tumour remnant with maximum diameter of 2.5 cm) of a huge cystic craniopharyngioma by frontotemporal approach, followed by early external fractionated radiotherapy by linear accelerator. Serial magnetic resonance imaging during a follow-up period of 5 years showed a progressive marked reduction of the tumour remnant, accompanied by a complete recovery of visual deficits and an almost complete regression of diencephalic disturbances. Conclusions: Subtotal removal followed by early fractionated radiotherapy can be an effective treatment for huge craniopharyngiomas. Such a multidisciplinary treatment may favour tumour control and assure a satisfactory quality of life as well.