Ectopic recurrence of craniopharyngiomas: case report

Craniopharyngiomas are benign tumors that originate from squamous cell rests of the embryonal hypophyseal-pharyngeal duct located along the pituitary stalk. After their surgical resection, recurrence usually occurs in the region of the original tumor bed. Ectopic recurrence of craniopharyngiomas is extremely rare. It usually occurs either along the surgical route, because of direct surgical seeding, or at a distal location in the subarachnoid space, because of seeding along the cerebrospinal fluid pathways. We present 3 examples of ectopic recurrences of craniopharyngiomas. The first patient was a 52-year-old woman with a history of resected suprasellar craniopharyngioma presenting 15 years later with a history of balance problems and new onset of double vision. Her magnetic resonance imaging scan revealed a tumor in the prepontine cistern. The second patient was a 41-year-old man with a history of a resected suprasellar craniopharyngioma presenting 9 years later with headache, dizziness, and disequilibrium. He was noted by his family to have an altered behavior with progressively increasing indifference. His magnetic resonance imaging scan showed a right frontal lesion in the vicinity of the sylvian fissure. The third patient was a 24-year-old man with a history of suprasellar craniopharyngioma resection, followed by conventional radiotherapy 12 years before his recent presentation with headache, numbness of the right side of his face, and increased drowsiness. His magnetic resonance imaging scan showed a bilateral cystic cerebellopontine angle lesion. The first patient underwent operation via a petrosal approach with subtotal resection of the tumor and decompression of the brainstem; this patient had an uneventful postoperative course. The tumor in the second patient was surgically resected through a pterional craniotomy, with an uneventful postoperative course. The third patient's right-sided cerebellopontine angle lesion was microsurgically resected, and the patient was given a single-dose gamma knife for the left-side and residual small right-side tumor. The histological diagnosis of all 3 lesions was craniopharyngioma. Although ectopic recurrence of a craniopharyngioma is very rare, it should always be considered in the differential diagnosis of what appears to be a new tumor in a patient with a history of previously resected craniopharyngiomas. Long-term follow-up of patients with resected craniopharyngioma is very important.