Surgical management of giant suprasellar craniopharyngioma in a 3-year-old: Case report with a review of the literature

Abstract

Craniopharyngiomas are among the most challenging tumors to manage in children. The tumor’s proximity to critical neural structures poses significant management challenges, as these structures are still developing and highly sensitive to intervention. We report a case of giant craniopharyngioma in a 3-year-old boy, which was managed successfully with complete excision, and the patient recovered well. The patient was admitted with a history of chronic headache and vomiting that had persisted for one month. His social, language, and cognitive developments were normal with no overt neurological deficits. Contrast-enhanced Magnetic Resonance Imaging (MRI) revealed a complex multiloculated cystic mass, measuring 52 × 53 × 51 mm and occupying sellar and suprasellar regions, with heterogeneous enhancement. The tumor compressed the hypothalamus anterosuperiorly, displaced the optic chiasm, and stretched the bilateral optic tracts. He underwent a pterional craniotomy with near-total tumor resection, removing the lesion within its capsule. In the post-operative period, he developed diabetes insipidus (DI) but otherwise did well. Histopathology confirmed adamantinomatous craniopharyngioma. Management strategies for pediatric craniopharyngiomas have dramatically changed with advances in surgical techniques, imaging modalities, and perioperative management. Substantial morbidity is still possible, and their management is best pursued in a multidisciplinary manner. Surgical technique and extent of resection must be judiciously chosen to match tumor characteristics and location.