**Recent Trends**

**Chapter 8**

Provisional chapter

**Modern Management of Craniopharyngioma**

DOI: 10.5772/intechopen.74512

Craniopharyngiomas (CPs) have had a prominent place in neurosurgery due to both the technical difficulty and controversy regarding the optimal treatment of these benign tumors. Harvey Cushing famously described craniopharyngiomas in 1936 as "the most forbidding of the intracranial tumors." Seventy years later, Rutka still wrote: "There is no other primary brain tumor that evokes more passion, emotion, and as a result, controversy than does the CP." Craniopharyngiomas comprise 1–2% of all brain tumors and occur in a bimodal distribution, with 40% of cases occurring between age 5–15 years and 60% occurring at ages >55 years. The differential diagnosis for craniopharyngioma can include a variety of entities, including pituitary macroadenoma, metastasis, Rathke's cleft cyst, colloid cyst, glioma, meningioma, germinoma, abscess, sarcoid, or aneurysm. Imaging characteristics usually include a solid cystic lesion, speckled with calcifications in 50– 80% of craniopharyngiomas (especially pediatric patients), as well a presentation with hypopituitarism and diabetes insipidus, which influence clinical thinking toward

A 42-year-old woman presented, as a transfer from an outside hospital, with increased forgetfulness, fatigue, as well as intermittent double vision leading to accidents. In addition, she complained of increased thirst and urination. She was concurrently taking lithium and lorazepam for psychiatric reasons. Imaging with CT revealed a large suprasellar mass extending into the third ventricle (Figure 1). The patient had laboratory studies performed (Table 1) and underwent a formal ophthalmology examination, which revealed red desaturation and a

> © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and eproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

Keywords: craniopharyngioma, endoscopic, radiation, QOL, molecular

depressed visual field consistent with compressive optic neuropathy.

Modern Management of Craniopharyngioma

Anirudh Penumaka and Ekkehard Kasper

Anirudh Penumaka and Ekkehard Kasper

http://dx.doi.org/10.5772/intechopen.74512

establishing this diagnosis.

1. Clinical case vignette

Abstract

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

#### **Modern Management of Craniopharyngioma** Modern Management of Craniopharyngioma

DOI: 10.5772/intechopen.74512

Anirudh Penumaka and Ekkehard Kasper Anirudh Penumaka and Ekkehard Kasper

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.74512

#### Abstract

Craniopharyngiomas (CPs) have had a prominent place in neurosurgery due to both the technical difficulty and controversy regarding the optimal treatment of these benign tumors. Harvey Cushing famously described craniopharyngiomas in 1936 as "the most forbidding of the intracranial tumors." Seventy years later, Rutka still wrote: "There is no other primary brain tumor that evokes more passion, emotion, and as a result, controversy than does the CP." Craniopharyngiomas comprise 1–2% of all brain tumors and occur in a bimodal distribution, with 40% of cases occurring between age 5–15 years and 60% occurring at ages >55 years. The differential diagnosis for craniopharyngioma can include a variety of entities, including pituitary macroadenoma, metastasis, Rathke's cleft cyst, colloid cyst, glioma, meningioma, germinoma, abscess, sarcoid, or aneurysm. Imaging characteristics usually include a solid cystic lesion, speckled with calcifications in 50– 80% of craniopharyngiomas (especially pediatric patients), as well a presentation with hypopituitarism and diabetes insipidus, which influence clinical thinking toward establishing this diagnosis.

Keywords: craniopharyngioma, endoscopic, radiation, QOL, molecular
