Craniopharyngiomas of the skull base are benign tumors that grow in the area of the pituitary gland. These tumors are most common in children. Almost half of all craniopharyngiomas develop in people under the age of 20.
The preferred surgical treatment at UPMC for craniopharyngioma is the Endoscopic Endonasal Approach (EEA) to remove the tumor. This innovative, minimally invasive technique uses the nose and nasal cavities as natural corridors to access hard-to-reach or previously inoperable tumors. EEA offers the benefits of no incisions to heal, no disfigurement to the patient, and a faster recovery time. If complementary treatments, such as radiation therapy, are needed, those therapies can begin soon after surgery.
The physician may perform a physical exam and ask about symptoms. Symptoms may include:
- nausea and vomiting
- balance problems
Other conditions may result from damage to the pituitary gland, including:
- hypothyroidism (weight gain, fatigue, cold intolerance, and constipation)
- adrenal failure (dizziness, hypoglycemia, cardiac arrhythmias, lethargy, confusion, anorexia, nausea, and vomiting)
- diabetes insipidus (excessive thirst and urination)
- decreased sexual drive, including impotence in men and amenorrhea in women
- delayed puberty and stunted growth in pediatric patients
- overeating, obesity, and sleepiness
The doctor may also recommend a neurological exam to evaluate vision, hearing, balance, coordination, and reflexes.
MRI or CT scans may be ordered to show the size and extent of the tumor. Depending on other symptoms, such as hormone and visual problems, you may be seen by an endocrinologist and an ophthalmologist.
Surgery is the primary treatment for craniopharyngiomas.
Craniopharyngiomas may be approached directly by using the Endoscopic Endonasal Approach (EEA). This approach gives a direct angle at the base of these tumors, providing extraordinary visualization via the endoscope, to allow for optimal tumor removal. The tumor is removed through the nose and nasal cavities, with no incisions to the face or skull, and recovery time is faster than with a traditional approach.
Although the goal of the surgery is total tumor removal with pituitary function preservation, in some cases the tumor's proximity to critical brain structures (the hypothalamus, optic chiasm, and blood vessels) makes complete removal impossible. The Expanded Endonasal Approach gives the surgeons the best view of the undersurface of the optic nerves, chiasm, and pituitary stalk, assisting them in deciding whether to leave residual tumor attached to these important structures. In cases where the tumor has clearly invaded the pituitary gland, the pituitary gland may be removed.
In instances where it is not safe to remove the tumor completely, surgery is followed by radiation therapy to eradicate the remaining tumor cells. This treatment option has success rates on par with those of complete tumor removal.