Control of Hydrocephalus in Craniopharyngiomas

Hydrocephalus is a complicating factor found in 15 to 30 percent of craniopharyngioma patients. Proper management of the enormous positional shifts that occur when treating the tumor and hydrocephalus simultaneously will help to avoid major complications. When the patient's symptoms and signs are solely related to increased intracranial pressure, treatment of hydrocephalus is indicated as a first step. However, decompression of the hydrocephalus may allow the tumor to change position. For example, a tumor located beneath the optic chiasm can cause greater stretching of the chiasm and a larger bitemporal field cut when the lateral ventricles are decompressed. Very rapid decompression of hydrocephalus may allow the cortex to fall away from the inner table, creating subdural hygromas or hematomas or even leading to venous thrombosis. Installing a shunting device preoperatively may make it difficult to control the rate of decompression. For this reason, valve-regulated external drainage may be useful for carefully controlling the rate of decompression.

Occasionally it may be useful to decompress the hydrocephalus and a cystic tumor simultaneously. In a recent case, a huge cyst filling the third ventricle caused hydrocephalus. Catheters placed in the cyst and ventricular system for 24 h allowed controlled decompression of both spaces, making the operation easier and facilitating total removal of the tumor.