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Chapter-078 Craniopharyngiomas

BOOK TITLE: Textbook of Contemporary Neurosurgery (2 Volumes)

Author
1. Kumaravelu Selvakumar
ISBN
9789350252390
DOI
10.5005/jp/books/11681_78
Edition
1/e
Publishing Year
2012
Pages
15
Author Affiliations
1. Sri Ramachandra University, Chennai, Tamil Nadu, India
Chapter keywords

Abstract

Craniopharyngioma is a slow-growing, extra-axial, benign tumor of dysembryogenesis, encountered predominately in the sellar/suprasellar region. Most common nonglial intracranial tumor in children. Pathogenesis is not completely understood; arise from epithelial nests in Rathke’s pouch (adamantinous type) or metaplastic from mature cells of the anterior hypophysis (squamous papillary type). Bimodal age distribution (5-14 years and more than 50 years). Squamous papillary type is seen only in adults and easy to excise. The common adamantinous type is often cystic with calcifications and machine oil like cholesterol and keratin content; show aggressive local behavior and brain invasion and not amenable for total excision; even gross total removal does not prevent recurrence. Suprasellar with intrasellar extension is common. Hydrocephalus and hypothalamic disturbance is more common in children. Visual and endocrine disturbance is more common in adults. Sellar tumors may be excised by transsphenoidal surgery. Hypothalamus and pituitary stalk should be protected during transcranial surgery. Subtotal resection combined with radiation is the standard treatment. Intracavitary chemotherapy with the antibiotic, bleomycin is occasionally used; no role for systemic chemotherapy. Patient and family education plays a major role in long-term treatment of endocrinological and psychological management.

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