Craniopharyngioma

Summary

Craniopharyngiomas are the most common supratentorial tumor of children. They are derived from Rathke’s pouch, which is a fetal structure comprised of surface ectoderm, that eventually gives rise to the anterior pituitary gland. While they are technically benign tumors, craniopharyngiomas can cause hypopituitarism through mass effects on the pituitary gland. Additionally, these tumors can cause bitemporal hemianopsia due to compression of the nearby optic chiasm. Craniopharyngiomas appear calcified on CT, and surgical resection will show a cystic tumor filled with brownish / yellow motor-oil like fluid.

Key Points

• Craniopharyngioma
  • Epidemiology
    • Found in children
      • They are the most common childhood supratentorial tumor
  • Embryology
    • Derived from remnants of Rathke’s pouch
      • This means that it is derived from surface ectoderm (NOT neuroectoderm)
      • Rathke’s pouch is an invagination from the roof of the mouth that gives rise to the anterior pituitary
  • Imaging
    • Calcifications on CT
  • Signs and Symptoms
    • Bitemporal hemianopia due to optic chiasm compression
      • May therefore be confused with pituitary adenoma (calcifications can help differentiate)
    • Hypopituitarism
    • Motor-oil like fluid found within tumor
      • Due to cholesterol crystals
  • Treatment
    • Surgical resection
      • Tumors are benign and exert their damage via mass effect