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Washington University Experience | NEOPLASM (SELLAR) | Craniopharyngioma, adamantinomatous | 20A0 Case 20 History
Case 20 History ---- The patient was a 49 year old male, who presented to BH with a known suprasellar craniopharyngioma diagnosed at the Mayo Clinic approximately 2 1/2 years prior following symptoms consisting of a dull, generalized headache, increased fatigue, weight gain, forgetfulness, chills and drenching night sweats. An EMI scan demonstrated a suprasellar mass with calcification and no change with contrast thought to be a craniopharyngioma. Surgery was not advised since the tumor appeared not responsible for any of the patient's symptoms. He returned periodically but with continued symptoms. He experienced bifrontal headache, easy fatigue, weight gain continued, polydipsic, loss of libido. He was admitted to the hospital for complete neurologic evaluation with a possibility of a craniotomy with tumor removal. Skull x-rays demonstrated mottled calcifications in the suprasellar area with an eroded dorsum sellae. An EMI showed a partly calcified mass in the suprasellar region rising up to the level of the third ventricle and replacing part of it. At frontotemporal craniotomy revealed a craniopharyngioma; however, during the procedure, an irreparable tear developed in the right internal carotid. The artery was initially packed, then both distal and proximal clamps were positioned. Post-operatively the patient recovered to his pre-operative neurologic status. Post-operative complications included a urinary tract infection adequately treated with antibiotics, diabetes insipidus treated with Pitressin, and replacement hormones including thyroid and cortisone. The patient continued a. satisfactory post-operative course, until 15 days after the operation. At that time he was found unresponsive in his bed with agonal breathing. All attempts at resuscitation including intubation, vasopresser substances intravenously, and external cardiac massage were unsuccessful and the patient succumbed.
