Craniopharyngiomas:
Although these lesions are histologically benign, their location often presents surgical excision with potentially devastating neurological complications. Craniopharyngiomas are close to the hypothalamus and pituitary stalk and the presentation can include both behavioral (neuro) as well as endocrinological dysfunction of the pituitary hormones. They are rare and represent roughly 3.5% of all intracranial tumors being much more common in children and have a bimodal distribution with the first peak occurring at 5-10 years of age, and the second between 55-65 years of age.
The treatment algorithm depends upon age, medical state and the tumor characteristics (solid or cystic). An attempt for surgical excision in the solid tumors for the most part is the best option, however residual tumors can be treated by radiotherapy. Cystic lesions are often treated with intracystic B-radionuclide such as 32P or 90Y. If the cyst shrinks as a result of this treatment then stereotactic radiosurgery (i.e. Gamma Knife) follows. If there is a solid remnant after shrinkage, surgery will be the recommended treatment option.
Thorough evaluation including CT scans MRI’s MRA with endocrine and ophthalmological work up is necessary prior to any decision. Hydrocephalus can be treated by shunts.