2026 Poster Presentations
P270: MINIMALLY INVASIVE MANAGEMENT OF RECURRENT CRANIOPHARYNGIOMA: INTRAOPERATIVE REAL-TIME MRI-GUIDED TRANSNASAL CYST ASPIRATION
Oyku Ozturk, MD1; Emetullah Cindil, Assoc Prof, MD2; Metin E Demirkan, MD3; Muammer M Sahin, Assoc Prof, MD3; Emrah Celtikci, Assoc Prof, MD1; 1Gazi University Faculty of Medicine, Department of Neurosurgery; 2Gazi University Faculty of Medicine, Department of Radiology; 3Gazi University Faculty of Medicine, Department of Otorhinolaryngology/Head and Neck Surgery
Background: Craniopharyngiomas are rare benign epithelial tumors located in the sellar and suprasellar region, accounting for a small proportion of intracranial neoplasms. Standard management typically involves surgical resection followed by adjuvant radiotherapy when indicated. However, recurrent cystic craniopharyngiomas pose significant challenges due to their location, potential adherence to critical neurovascular structures, and higher risk associated with repeat surgical intervention. Minimally invasive, image-guided strategies may offer an alternative for select patients, reducing morbidity while achieving effective cyst management. Herein, we report a case of recurrent cystic craniopharyngioma treated using intraoperative real-time magnetic resonance imaging (MRI) and neuronavigation-guided transnasal aspiration.
Case Description: We present a 77-year-old female with a history of endoscopic transnasal resection of a cystic adamantinomatous craniopharyngioma. During routine follow-up, MRI identified a recurrent suprasellar cystic lesion causing mild mass effect on surrounding structures. Given the patient’s age and comorbidities, conventional reoperation was considered high risk. The recurrent cyst was accessed transnasally using an external ventricular drainage (EVD) catheter under neuronavigation guidance. Intraoperative real-time MRI using fast low-angle shot (FLASH) sequences enabled continuous visualization, confirming accurate catheter placement and gradual decompression of the cyst. The procedure was completed without any intraoperative complications, and immediate postoperative imaging demonstrated a significant reduction in the cyst.
Conclusion: This case illustrates a safe and effective minimally invasive approach for the management of recurrent cystic craniopharyngiomas. Real-time MRI-guided transnasal cyst aspiration allows precise targeting, continuous intraoperative monitoring, and immediate verification of cyst decompression, thereby minimizing surgical risk. This technique may be particularly valuable in elderly patients or those with comorbidities where repeat open surgery is contraindicated or carries increased morbidity. Further studies may help establish the role of image-guided cyst aspiration as a first-line strategy in select cases of recurrent craniopharyngioma.
Keywords: craniopharyngioma, cyst aspiration, intraoperative MRI, neuronavigation, skull base surgery
Abbreviations: EVD, External Ventricular Drainage; FLASH, Fast Low-Angle Shot; MRI, Magnetic Resonance Imaging