Partial recover of Partial recover of blindness after blindness after

eendoscopic treatment of ndoscopic treatment of suprasellar cystic suprasellar cystic

craniopharyngioma: case craniopharyngioma: case reportreport

Domagoj Jugović Domagoj Jugović Peter SpazzapanPeter SpazzapanAndrej PorčnikAndrej PorčnikBorut PrestorBorut Prestor

University University MMedical edical CCenter Ljubljanaenter Ljubljana

CASE REPORTCASE REPORT

20072007

• Right sided temporal Right sided temporal hemianopsia hemianopsia

• MRIMRI: : 1100 mmm m cystic cystic lesion in the suprasellar lesion in the suprasellar space with no space with no compression of optic compression of optic nerves and chiasmnerves and chiasm

• No endocrinological No endocrinological abnormalitiesabnormalities

20102010

• Worsening of right Worsening of right sided temporal sided temporal hemianopsiahemianopsia

• MRI: increase in cyst’s MRI: increase in cyst’s size (20 mm) with size (20 mm) with upward compression upward compression of optical cof optical chhiasmaiasma

• Refusal of surgeryRefusal of surgery

Visual evoked potentials in 2011Visual evoked potentials in 2011

  

RIGHT EYERIGHT EYE LEFT EYELEFT EYE

Latency (ms)Latency (ms) Amplitude (Amplitude (V)V) Latency Latency (ms)(ms)

Amplitude Amplitude ((V)V)

VEP CPVEP CP val val P100P100 120120 (110)(110) 2.82.8 (5.3)(5.3) 141141 (110)(110) 1.21.2 (5.3)(5.3)

DPPDPP val val P100P100 -- (108)(108) 00 (3.2)(3.2) -- (108)(108) 00 (3.2)(3.2)

LPPLPP val val P100P100 101101 (108)(108) 4.44.4 (3.2)(3.2) 115115ww (108)(108) 2.62.6ww (3.2)(3.2)

CASE REPORTCASE REPORT

20122012

• Acute onset of blindnessAcute onset of blindness

• Pupils fixed and dilatedPupils fixed and dilated

• Optic disc bilaterally paleOptic disc bilaterally pale

• MRIMRI:: further increase in size to 30x40 mm further increase in size to 30x40 mm

2007 2008

2010 20122012

Transventricular Transventricular endoscopic approachendoscopic approach

Transventricular Transventricular endoscopic approachendoscopic approach

• Cysto-cisterno-ventriculostomyCysto-cisterno-ventriculostomy

• Decompression of optic nerves and Decompression of optic nerves and chiasmchiasm

• Fast procedureFast procedure

• Low morbidity and mortality reported Low morbidity and mortality reported in literaturein literature

Superior part of the cyst through the right foramen of Monroe Cystoventriculostomy

Cystocisternostomy Ventriculostomy

POSTOPERATIVE MRIPOSTOPERATIVE MRI

Postoperative visual evoked Postoperative visual evoked potentialspotentials

  

RIGHT EYERIGHT EYE LEFT EYELEFT EYE

Latency (ms)Latency (ms) Amplitude (Amplitude (V)V) Latency Latency (ms)(ms)

Amplitude Amplitude ((V)V)

VEP CPVEP CP val val P100P100

122 (110)(110) 2.5 (5.3)(5.3) 105105 (110)(110) 5.35.3 (5.3)(5.3)

DPPDPP val val P100P100 -- (108)(108) 00 (3.2)(3.2) 104104 (108)(108) 4.04.0 (3.2)(3.2)

LPPLPP val val P100P100 105105 (108)(108) 3.03.0 (3.2)(3.2) 110110 (108)(108) 2.32.3 (3.2)(3.2)

OCTOPUSOCTOPUS

Right eye 2012 Left eye 2012

Right eye 2013

Left eye 2013

CONCLUSIONSCONCLUSIONS

• Blindness due to COMPRESSION of optic Blindness due to COMPRESSION of optic nerves and chiasm can be reverseblenerves and chiasm can be reverseble

• Importance of early decompressionImportance of early decompression

• Surgical decision depends on location, Surgical decision depends on location, structure and clinical picturestructure and clinical picture