**21. Craniopharyngioma**

They are low histological grade (WHO I) tumours which arise from epithelial remnants of rathke's pouch. They are usually located in sellar or parasellar location with an overall incidence of 0.5–2.0 new cases per million of the population per year, and constitute 1.2–4.0% of all childhood intracranial tumors.

Symptoms depend upon the location of the tumour:

Craniopharyngimas can present with nonspecific symptoms like headache and nausea due to increased intracranial pressure.

Intrasellar lesions can compress the pituitary gland and hypothalamus involving the hypothalamic-pituitary axes in 52–87% cases, leading to endocrine defects, particularly deficits in the secretion of growth hormone (75% of cases), gonadotropins (40%), adrenocorticotropic hormone (25%) and TSH (25%) [81].

Prechiasmal lesions may compress the optic pathway, leading to visual field cuts, decreased central visual acuity or vision impairment (62–84% of cases in children).

Retrochiasmal lesions may grow into the third ventricle and cause hydrocephalus or compress the optic tracts.

Craniopharyngiomas can cause direct impingement of brain parenchyma and produce neurological deficit.

In case of localized tumours the preferred choice of treatment is complete resection with preservation of visual, pituitary and hypothalamic function [82]. In case of incomplete resection, there are chances of residual tumour progression in 71–90% of patients, whereas the rate of progression after incomplete resection followed by radiotherapy is 21%. Therefore radiotherapy is recommended after surgical resection [83].
