Background
Craniopharyngiomas are benign, extra-axial, slow-growing tumors that arise from the anterior margin of the sella turcica and predominantly involve the sella and suprasellar space.
They rarely metastasize but are locally invasive (typically the hypothalamus), and treatment, particularly surgical attempts at total resection, can result in significant morbidity.
As craniopharyngiomas grow, they can cause significant neurologic complications, including visual loss, pituitary insufficiency, and hypothalamic damage, and recurrence, both local and meningeal, is often seen and adds to patient morbidity. Malignant transformation of craniopharyngiomas is rare but has been reported after multiple recurrences and after radiation.
The first description of a craniopharyngioma is credited to Zenker, who made this observation in 1857. Following this, Mott and Barrett, in 1899, documented the occurrence of these tumors and postulated that they arose from the hypophyseal duct or Rathke pouch. This was subsequently partially confirmed in 1904, when Erdheim described the tumors histologically and suggested that they arose from remnants of the Rathke duct. Finally, in 1932, Cushing introduced the term craniopharyngioma, which came to be widely used thereafter.
Evolution of surgical treatment for craniopharyngiomas is closely related to development of the surgical techniques of sella turcica. The first surgical techniques for craniopharyngioma originated in 1891 with the first trepanation done by Selke, followed in 1907 by the first successful transcranial approach performed by Horsley.
The progress of the surgical techniques continued with the first successful resection of craniopharyngioma through a transsphenoidal approach by Eiselsberg in 1910, which was improved by Halstead as a sublabial transsphenoidal resection in the same year. Cushing created the foundations of craniopharyngioma patient treatment with hormone replacement therapy, but also, in 1919, he developed and performed the first successful resection through the trans–lamina terminalis approach of a retrochiasmatic craniopharyngioma. Later, in 1924, he performed a transcallosal resection of a craniopharyngioma.
As technology in diagnostic imaging has improved, so has the surgical treatment of craniopharyngioma.
See Brain Lesions: 9 Cases to Test Your Management Skills, a Critical Images slideshow, to review cases including meningiomas, glioblastomas and craniopharyngiomas, and to determine the best treatment options based on the case history and images.