Craniopharyngioma

Diagnosis Definition

• Craniopharyngioma is a slow-growing, rare, histologically benign brain tumor affecting children between the ages of 5 and 14 and older adults

• It is extra-axial, arises near the pituitary gland, and commonly contains solid and cystic components

• Pressure on the pituitary gland and optic nerves produces headache, visual symptoms and endocrine abnormalities

• The most common type, adamantinomatous, is seen predominantly in children

• The tumor often contains single or multiple cysts filled with thick oily fluid rich in protein, blood products, and/or cholesterol, giving the so-called “motor oil” fluid appearance

Imaging Findings

• Solid components are variable in intensity on T1 and T2 imaging and enhance vividly on T1 imaging with contrast

• Cysts are variable in signal on T1 imaging due to high protein content and blood products, and variable but usually hyperintense on T2 imaging

• Large tumors often compress the midbrain, causing obstructive hydrocephalus

KEY IMAGES

Pearls

• Appoximately 90% of craniopharyngiomas have calcifications, 90% have cysts, 90% enhance, and 90% are suprasellar

• CT scanning is preferred over MRI for showing calcification in the tumor

References

1. Plaza MJ, Borja MJ, Altman N, Saigal G. Review. Conventional and advanced MRI features of pediatric intracranial tumors: posterior fossa and suprasellar tumors. AJR 2013; 200:1115-1124