Ectopic Craniopharyngioma Recurrence: A Case Report and Literature Review.

Craniopharyngiomas are tumors of the central nervous system, typically located in the sellar/parasellar region. Despite being benign, they behave aggressively due to their propensity to invade nearby important structures, making total resection challenging. Distant spread of craniopharyngioma is a rare but significant complication. Most cases result from spread along the surgical path, while others result from dissemination along the cerebrospinal fluid (CSF) pathways. We report a case of a parasellar adamantinomatous craniopharyngioma with progressive visual loss. The patient was operated on through a right pterional craniotomy three times due to recurrence. After the last surgery, fractionated stereotactic radiotherapy was performed on the tumor residue. On follow-up brain MRI, a new extra-axial lesion was found in the left frontal region with solid and cystic components, with apparent dural implantation. Left frontal craniotomy was performed, and the lesion was excised with resection of its dural implant. Histological findings revealed it to be adamantinomatous craniopharyngioma, grade 1, according to the World Health Organization (WHO). Despite being rare, craniopharyngioma ectopic recurrence is a possible surgical complication. Despite the poorly understood mechanism, the literature highlights the importance of paying attention to tumor spillage during surgery to prevent distant recurrences.

Vestibular Schwannoma Leading to Contacting Aneurysm Rupture: An Unusual Presentation.

Subarachnoid hemorrhage (SAH) is a rare manifestation of brain tumors, being even rarer in vestibular schwannomas. We report the second case of a posterior circulation aneurysm close to the tumor capsule, responsible for SAH as an initial manifestation of a vestibular schwannoma. A 67-year-old female was admitted to the Emergency Department with sudden onset of nausea and headache. A diagnosis of a SAH and a tumor of the right cerebellopontine angle was made. An angiography showed an aneurysm in the dependency of the right anterior inferior cerebellar artery (AICA), juxtaposed to the tumor capsule. The patient underwent surgery, the tumor was removed, and the aneurysm was treated. This case highlights that SAH in patients with vestibular schwannoma may originate from a contact aneurysm. Although exceedingly rare, surgeons should consider this scenario in vestibular schwannoma presenting with SAH, and angiography is important for its diagnosis.