Pediatric Craniopharyngioma

  • Etiology:
    — Benign dysontogenetic epithelial tumor arising from cell remnants of Rathke’s pouch
  • Imaging:
    — Bimodal age distribution: I child (5-15 years old) tumor is adamantinomatous and typically cystic and often has calcification, in adult (50-70 years old) tumor is papillary and typically solid
    — Location – 70% suprasellar and 20% supra-intrasellar and 10% intrasellar, rarely in third ventricle or sphenoid sinus or clivus, can grow posteriorly over dorsum sella, note tumor position in relation to optic chiasm as if posterior to chiasm is retrochiasmatic (most common) while if anterior to chiasm is prechiasmatic
    — 95% type of tumor – 95% calcify, 95% suprasellar, 95% cystic component
  • Imaging CT: Can demonstrate calcification in 90%
  • Imaging MRI:
    — T1WI: Cystic components variable in signal depending on protein concentration and presence of cholesterol cysts
    — T1WI post contrast: Solid portions of tumor enhance and there is rim enhancement of cystic components
  • DDX:
  • Complications:
  • Treatment: Surgical
  • Clinical:
    — Presents in early second decade with growth hormone deficiency
    — Most common suprasellar mass in children

Radiology Cases of Craniopharyngioma

MRI of craniopharyngioma
Lateral radiograph of the skull (top image) shows an enlarged sella turcica. Sagittal TI MRI without and with contrast of the sella (middle two images) shows a large heterogenous mass arising in the sella and extending superiorly into the suprasellar region that shows primarily rim enhancement with contrast. Coronal T2 MRI of the sella (bottom image) shows the sellar and suprasellar mass to have a high signal intensity implying it has cystic and or proteinaceous components.