Intracranial fusiform aneurysm following microsurgery for adult craniopharyngioma: Clinical experience and review of literature

Background: Fusiform dilation of the supraclinoid ICA are not infrequently found in children with craniopharyngiomas, however, they occur much less frequently in adults with craniopharyngiomas. We report an adult patient with recurrent craniopharyngioma with FDCA, and discuss the diagnostic evaluation and management of them. Case description: A 46 years old male patient, farmer by profession of Mongoloid race and Han ethnicity was admitted in ward 19 on January 2005 with polyuria more than 3 L, polydipsia with intake of fluids up to 3 L per day, bilateral frontal headache and decrease vision of bilateral eyes since 1 year. He further noticed severe deterioration of right visual acuity since 4 months. He was diagnosed as craniopharyngioma and had his first operation. The postoperative period was smooth until he started noticed decreased bilateral vision since January 2006. The repeat CT and MRI showed recurrence of the tumor. The intraoperative findings were as follows: there was a recurrence of the lesion which was cystic and had calcifications. The adjacent ICA was found to be FDCA. The craniopharyngioma was resected totally together with clipping of the FDCA. Postoperatively the patient was conscious and had spontaneous breathing, and resumed some of his labor five months later. 13 years after the operation, there was no evidence of recurrence in the MRI scan. Conclusions: Though the FDCA is very rare in adults with craniopharyngiomas, it can be treated with the operation.