Management of a giant recurrent craniopharyngioma: a clinical case report

Yasuri E. Canche-Ruiz, Department of Anesthesiology, General Hospital “Dr. Agustin O’Horan”, Servicios de Salud del Instituto Mexicano del Seguro Social para el Bienestar (IMSS-BIENESTAR); Department of Medical Specializations, School of Medicine,Universidad Autónoma de Yucatan; Mérida, Yucatán, Mexico
Pedro F. Ramirez-Sánchez, Department of Anesthesiology, General Hospital “Dr. Agustin O’Horan”, Servicios de Salud del Instituto Mexicano del Seguro Social para el Bienestar (IMSS-BIENESTAR), Mérida, Yucatán, Mexico
Mitzi F. Fernandez-Luna, Department of Anesthesiology, General Hospital “Dr. Agustin O’Horan”, Servicios de Salud del Instituto Mexicano del Seguro Social para el Bienestar (IMSS-BIENESTAR), Mérida, Yucatán, Mexico
Ludwig A. Becerril-Mendez, Department of Anesthesiology, General Hospital “Dr. Agustin O’Horan”, Servicios de Salud del Instituto Mexicano del Seguro Social para el Bienestar (IMSS-BIENESTAR), Mérida, Yucatán, Mexico
Fernando A. Ancona-Cat, Department of Anesthesiology, General Hospital “Dr. Agustin O’Horan”, Servicios de Salud del Instituto Mexicano del Seguro Social para el Bienestar (IMSS-BIENESTAR), Mérida, Yucatán, Mexico
Nina I. Mendez-Domínguez, Hospital Regional de Alta Especialidad de la Península de Yucatán, Servicios de Salud del Instituto Mexicano del Seguro Social para el Bienestar (IMSS-BIENESTAR), Mérida, Yucatán, Mexico

Craniopharyngioma (CP), a benign embryonic tumor with aggressive clinical behavior, poses significant anesthetic challenges due to its proximity to critical neuroendocrine structures. We present the perioperative management of a 17-year-old male with a giant recurrent CP who underwent bicoronal craniotomy with bispectral index-guided multimodal anesthesia, invasive hemodynamic monitoring, and strict endocrine control. Hemodynamic and metabolic stability were maintained, ensuring adequate cerebral perfusion. Transient polyuria occurred without hyponatremia, osmolar disturbances, or signs of diabetes insipidus or cerebral salt-wasting syndrome. Multimodal anesthesia, supported by invasive monitoring and close neuroendocrine surveillance, optimized surgical conditions and facilitated early recovery.

Keywords: Craniopharyngioma. Multimodal anesthesia. Invasive monitoring. Hypothalamic-pituitary tumor. Neurological surgery.