Craniopharyngiomas

Craniopharyngiomas (CPs) are rare tumors arising from the developmental Rathke’s pouch and present in a bimodal distribution peaking at 5 to 14 and 50 to 74 years. Symptoms at onset include visual loss, headache, and hypopituitarism. Most tumors contain solid and cystic components, and fluid within the cyst usually contains cholesterol crystals. Histopathology is classified into adamantinomatous (most common in children) and papillary (almost exclusively in adults) subtypes. Magnetic resonance imaging is the definitive diagnostic modality for sellar and suprasellar lesions. In addition to imaging, formal visual evaluation and detailed endocrinologic workup are a critical aspect of preoperative assessment. The role of radical surgical resection, versus decompression combined with radiotherapy, remains controversial. The most common complications of surgical and radiotherapeutic treatments include pituitary stalk and hormonal deficiencies, along with cerebrospinal fluid leak. As 5-year overall survival for patients with CP is in the range of 55% to 85%, CP remains a challenging condition to treat and requires a multidisciplinary approach.