Treatment of giant cystic craniopharyngiomas

We report two patients with giant cystic craniopharyngiomas approached tran ssphenoidally, with continuous cyst drainage through a silastic tube, conne cting the cyst with the sphenoid sinus. An innovative technique for fixatio n of the tube and reconstruction of the sphenoid sinus is presented which c onsists of the use of a combination of silk, resin and calcium carbonate. P ostoperatively, although both patients developed diabetes insipidus, both p atients improved neurologically. At follow-up examinations (32 and 48 month s), neither patient had migration of the silastic tube, evidence of meningi tis, nor cerebrospinal fluid leak. We propose this technique as a surgical alternative for large cystic craniopharyngiomas on which attempt of total r esection carries a high risk of severe neurological complications.