Sella bugged!!! - Abscess inside a Craniopharyngioma - Case report with literature review.

Introduction Abscess within a craniopharyngioma is extremely rare and only 8 such cases have been reported in literature. Most patients present with hypopituitarism and visual disturbances. We report the first ever case of a craniopharyngioma with abscess in a pediatric patient. Case report A 10-year-old girl presented with visual deterioration and bitemporal hemianopia. Her CT and MRI brain suggested of a sellar-suprasellar craniopharyngioma. Due to ill-developed sino-nasal anatomy, a transcranial approach was made for the lesion. The lesion was well capsulated, thick walled and appeared inflamed. Upon incising the wall, thick yellowish pus was drained out in a controlled manner. This was followed by a partial resection of the craniopharyngioma wall and eccentric, adhered, calcified residue was left behind with an Ommaya drain. The abscess culture grew Enterococcus species and histopathology revealed adamantinomatous craniopharyngioma. Patient underwent culture sensitive antibiotics course followed by radiation for the residue. She was doing well at one year follow up with clinical and radiological improvement. Conclusion This is the first report of a pediatric case with secondary abscess in craniopharyngioma. Operative management of such a case includes controlled drainage of pus without dissemination into the surrounding arachnoid space. The tumour and abscess have to be addressed as separate surgical entities; infection control and wherever complete resection is not feasible, partial safe resection followed by radiotherapy is a viable option.