Craniopharyngioma treatment

It’s a benign slow-growing tumor of the skull base.

• Occurs at any age,
• Often affects children 5-14 years,
• Is rare and accounts for 2.5-4% of all neoplasms of the brain.

Craniopharyngioma results from abnormal growth of certain brain cells that proliferate uncontrollably for unknown reasons and gradually form a tumor that grows inside the skull.

• Adamantinomatous — affects children and adolescents, often recurs,
• Papillary — more common in adults, rarely relapses.

The tumor does not spread to other parts of the body, but grows within the confined space of the skull, pressing on important nearby structures and causing a range of problems.

In the early stages, the growth is too small to cause symptoms. The first signs appear when the size of the tumor is large and reaches 2.5-3 cm, which interferes with the normal functioning of the brain.

There are such clinical manifestations:

• Intracranial hypertension — increases pressure inside the skull. Accompanied by headaches, nausea, and vomiting,
• Vision problems — decreased vision in one or both eyes. In severe cases, blindness,
• Hormonal disturbances — delayed growth and puberty, obesity, or underweight,
• Neurological disorders — problems with memory and concentration, mood changes.

The first manifestations don’t often alert parents or doctors: headaches are attributed to overwork or stress, nausea, and vomiting — to transport trips.

When the manifestations become expressive, it makes parents anxious, and the doctor suspects the presence of brain neoplasm.

The preferred diagnostic method — MRI with a contrast, which visualizes the location and size of the tumor.

Patients with suspected craniopharyngioma endocrinological examinations are recommended to detect possible hormonal disorders.

Ophthalmologic examination performed if MRI images show that tumor is detected in contact with a place crossing of optic nerves.

Initial treatment depends on the location and size of the tumor but always involves surgery.

Due to the proximity to vital structures of the brain, partial neoplasm removal is often performed. In the case of tumor residue or recurrence, to avoid surgery, radiation therapy sessions are activated.

When craniopharyngiomas are small and difficult to operate, some hospitals develop a «gamma knife» technique. This method treats neoplasms without surgery. With such a differentiated approach, therapy usually ends in one session.

Patients with craniopharyngioma should be operated on by a neurosurgeon in the center with specialized departments of endocrinology, ophthalmology, and radio-oncology experienced in pituitary surgery.

Craniopharyngioma «gamma knife» surgery is difficult, with a risk of death of 1-10%.

• Damage to the optic nerves is irreversible,
• Even if the tumor is removed, there is a risk of recurrence, which is 35-70%,
• It’s not always necessary to strive for the complete removal of tumors, since the frequency of complications increases with radical surgery:
  • After surgery, diabetes insipidus is found in 70-90% of patients,
  • Hormonal failure is detected in 80-90% of cases.

• Prognosis depends on when the tumor is found and whether it can be removed completely,
• A combination of surgery and radiation therapy results in 70-83% cases,
• Visual impairments and neurological problems that existed before surgery are usually not treatable with surgery,
• Up to 30% of patients with craniopharyngioma are obese. Therefore, there is a high risk of diabetes and heart disease.