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9 Cards in this Set

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Craniopharyngioma

What is the source of craniopharyngiomas?
Craniopharyngioma

What is the source of craniopharyngiomas?

Dysontogentic midline tumors originating from Rathke's pocket or ductus craniopharyngicus
Craniopharyngioma

Where are they typically located?
Craniopharyngioma

Where are they typically located?

Near the sella; close connection to the pituitary gland, hypothalamus, chiasma opticum, and visual nerves
Craniopharyngioma

Main symptoms
Craniopharyngioma

Main symptoms

Visual impairment or loss of vision
Visual field impairment (bitemportal hemianopia)
Endocrine dysfunction
- Dwarfism
- Fat tissue disturbances
- Adrenal cortex insufficiency
Craniopharyngioma

Typical appearance on
- MRI
- CT
- Skull radiographs
Craniopharyngioma

Typical appearance on

MRI: Midline cystic or mixed solid and cystic tumor

CT: Typical calcifications

Plain films: Sella expansion
Craniopharyngioma

Primary therapy
Craniopharyngioma

Primary therapy

Complete resection = cure
- 10yr control 60-93%

Postop after effects
- Visual impairment 20%
- Panhypopituitarism up to 95%
Less radical surgery with adj RT is preferred
Craniopharyngioma

Recurrence rate
- After subtotal resection
- Adj RT
Craniopharyngioma

Recurrence rate
- After subtotal resection: 30%
- Adj RT: 80-95% at 5-20 yrs
Craniopharyngioma

RT options
Craniopharyngioma

RT options

Conformal RT
SRT
Craniopharyngioma

SRT
- Rationale
- Dose
- Local 10-yr control
Craniopharyngioma

SRT

- Preferred due to the proximity to the chiasm and the visual nerves
- Dose
- 100% (Heidelberg)
-- CR 4/26
-- PR 14/26
-- Stable 8/26
-- Improved vision 5/26
-- No radionecroses, second malignancies, or visual deterioration
Craniopharyngioma

Conformal RT
- Dose
- Outcomes
Craniopharyngioma

Conformal RT
- Dose: 50-54 Gy
- Outcomes
-- Visual deterioration: Up to 10%
-- Severe side effects < 2%
--- Radionecroses
--- Cognitive changes
--- Secondary malignancies