CP-01. Therapeutic difficulty in the management of a recurrent craniopharyngioma in a child: case report and litterature review

Background Craniopharyngiomas are rare benign epithelial tumors of embryonic origin arising from Rathke’s pouch along the craniopharyngeal canal. The optimal treatment algorithm remains a challenge. We report the case of a child with a recurrent craniopharyngioma that poses a challenge for complementary therapy. Case presentation A 12-year-old patient, followed for a multioperated type 2 craniopharyngioma, stroke on left sylvian stenosis in 2020 during proton therapy (52 Gray), thrombolysed with good recovery, panhypopituitarism and right monocular blindness. He was seen in consultation for visual field deterioration. Clinical examination showed obese patient with a deteriorating visual field. Ophthalmological examination revealed a visual acuity of 10/10 with slight temporal visual field amputation on the left. Magnetic resonance imaging revealed progression of the residual multicystic lesion in the sellar and left temporal regions, penetrating into the sylvian valley and severely compressing the optic pathways. Tumor removal was performed, with release of the optic nerve, the carotid artery and its division, and the left 3rd cranial nerve. A tumour residue was left behind, as it was highly adherent to the lenticulostriate arteries. Post-operative management was straightforward. We were unable to suggest further treatment despite the risk of recurrence due to the previous stroke during proton therapy. Conclusion Despite advances in the management of craniopharyngiomas, this remains a challenge for medical teams. Current therapeutic approaches need to be reconsidered. This patient’s case is a typical example of the therapeutic difficulties associated with the management of craniopharyngiomas.