A craniopharyngioma is a usually benign but possibly aggressive tumor that is found near the pituitary gland. This is a structure connected to the brain that regulates the production of many hormones in the body. This tumor is most commonly found in boys and girls 5 to 14 years old, though it can happen in adults, too.
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Craniopharyngiomas are usually a mixture of both solid mass and fluid-filled cysts. They are not cancerous tumors, and they do not spread to other parts of the body. As they grow, however, they may press on parts of the brain and surrounding structures. This affects hormones, vision, and other normal functions. For this reason, they require treatment.
These are common symptoms of craniopharyngiomas:
Headache, including one that goes away after vomiting
Loss of balance or trouble walking
Unusual changes in energy level
Slow growth or delayed puberty
Increase in thirst
Increase in head size (in infants)
Tests that may lead a healthcare provider to suspect a craniopharyngioma generally include physical exams, neurological exams, and vision tests. CT and MRI scans are the primary tests used to confirm the diagnosis. Healthcare providers may also check the blood for levels of specific hormones, such as thyroid-stimulating hormone and adrenocorticotropic hormone (ACTH). These are secreted by the pituitary gland. Techniques like CT scans and MRIs may also be used to take pictures of the brain and detect tumors.
Once diagnosed, craniopharyngiomas are usually removed through surgery. The surgeon will decide if the tumor can be removed in its entirety, which can't always be determined before surgery. Sometimes, healthcare providers are not sure whether a tumor is a craniopharyngioma until the surgery begins.
Sometimes not all of the tumor can be removed through surgery because of the risk of damaging other structures. These structures include the optic nerve, hypothalamus, and carotid artery. When the entire craniopharyngioma can't be surgically removed, healthcare providers will usually try to remove as much of it as possible to relieve pressure on other body parts, and then use radiation therapy to get rid of what remains. Radiation therapy is generally given by external beam therapy. Experimental chemotherapy trials can be considered if the tumor returns after radiation.
The outlook for craniopharyngioma patients is good. Up to 90% of all patients have a chance of a permanent cure if the tumor can be completely removed with surgery. However, there is a chance that the tumor will return, especially if it is not all removed. Most recurrences happen within 2 years of surgery.
Other health effects may remain after treatment ends. Some common side effects of craniopharyngiomas include vision loss, obesity, behavioral problems, and the need for lifelong hormone replacement. One common side effect is loss of posterior pituitary gland function. This causes uncontrolled urination. It can be partially treated with hormonal therapy.