Fusiform Dilatation of the Internal Carotid Artery in Childhood-Onset Craniopharyngioma: A Systematic Review.

[OBJECTIVE] Patients with fusiform dilatation of the carotid artery (FDCA) following pediatric craniopharyngioma resection typically have a benign clinical course. We reviewed the neurosurgical literature for FDCA outcomes after resection of these tumors.

[METHODS] Using PubMed, Web of Science, and Cochrane databases, we identified surgical series or case reports reporting incidences of FDCA following craniopharyngioma resection. Inclusion criteria included FDCA outcomes reported specifically after craniopharyngioma resection, with at least 6 months of follow-up data.

[RESULTS] Our literature search yielded 15 full-text articles comprising 799 patients (376 [52.3%] males). The weighted mean follow-up was 74.8 months (range, 9-140 months). Most tumors were suprasellar (62.1%), with traditional microsurgery being more commonly employed than endoscopic endonasal surgery (80.9% vs. 19.1%). Gross total resection was achieved in 42.6% of cases. There were 55 aneurysms reported, most commonly occurring at the terminal internal carotid artery (66.7%). Aneurysmal progression on follow-up occurred in 10 (18.5%) cases, with no reports of rupture. Ten (18.2%) aneurysms were treated with clipping, endovascular, or bypass techniques.

[CONCLUSIONS] FDCA is a rare complication following pediatric craniopharyngioma resection. The exact cause is unclear, and factors related to tumor invasiveness, size, location, and differences in surgical approach may contribute to FDCA development. Most patients who go on to develop FDCA have an innocuous course on follow-up, with no reports of rupture in the present literature. For this reason, patients rarely require surgical or endovascular intervention for these lesions, and conservative management is favored.