A 50-year-old woman with a history of severe headaches, giddiness and progressive blurring of vision since two years presented with a complete loss of vision in left eye and had minimal vision in right eye. She had intermittent history of polyuria and had one episode of seizures in January 2017. She was a known hypertensive for 10 years and was on regular medications. On examination, she had vision of 6/36 in right eye and only vague perception of light (PL) in left eye. She was obese, but her vital parameters were normal. Her endocrinological work up (T3, T4, TSH, serum cortisol, GH, LH and FSH) was grossly normal. Her MRI brain (plain and contrast) revealed sellar, suprasellar and parasellar mass. The mass had solid and cystic component. It was multiloculated with left cyst of size 4x4cm and right cyst 3x3cm approximately.(Figure 1A&1B). The mass was engulfing bilateral Internal Carotid Artery (ICA), Anterior Cerebral Artery (ACA) and Middle Cerebral Artery (MCA) (Figure 1C&D). The solid component of the tumor had contrast enhancement (Figure 1E). The patient was taken for left frontotemporal craniotomy and tumour excision (left lateral subfrontal approach) under general anesthesia. The tumor had solid and cystic component. The cyst fluid was greenish in color and the tumor was occupying whole sellar, suprasellar and parasellar region. It was compressing bilateral optic nerves from below and was engulfing both ICA, ACA and MCA (Figure 2A). The tumor was resected in piecemeals and all the structures were made free of compression (Figure 2B). The patient gradually improved after surgery. She was electively ventilated for 24 hours and then weaned off. Her vision started improving after surgery. Post operatively the patient had transient Diabetes Insipidus (DI) with hypernatremia, which was managed by desmopressin and proper fluid intervention. Patient developed CSF rhinorrhea, which was managed by left frontal sinus packing with allogenic fat graft with bioglue along with lumbar drainage placement. The patient improved and the postoperative CT scan was suggestive of near total removal of the tumor with minimal sellar component (Figure 3). Her vision improved to finger counting at 6 feet in both eyes, and she was discharged in a stable state. The histopathological diagnosis was confirmed as adamantinomatous craniopharyngioma WHO grade I. She was advised radiation therapy in follow up in lieu of the small residual.
