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Craniopharyngioma (Transcranial Approach)

Last Updated: September 30, 2018

Resection of a Large Parasellar Craniopharyngioma via the Pterional Route

Craniopharyngiomas typically arise from nests of metaplastic adenohypophyseal cells of the hypophysiopharygneal duct (Rathke’s pouch). Except for the 5% that are purely intraventricular, almost all of these lesions are located within the parasellar chiasmatic cisterns.

Early proliferation of the tumor is contained within the subarachnoid space of the chiasmatic cistern, bordered laterally by the medial carotid cisterns, and posteriorly/superiorly by the interpeducular cistern separated by the diencephalic leaf of the Liliequist’s membrane. Following growth of the tumor mass and subsequent cisternal compression, the tumor infiltrates and fills the surrounding cisterns.

These tumors are often diagnosed at a large size due to their indolent and benign growth pattern. When larger than 4 cm, these tumors are considered giant and often demonstrate proliferation within multiple compartments of the subarachnoid space.

There are two pathologic subtypes of craniopharyngiomas: adamantinomatous and papillary subtypes. Adamantinomatous tumors are the childhood vari...