Craniopharyngioma

Cystic craniopharyngioma.

MRI – Sagittal T1, T2 and post gadolinium T1 and Axial T2 and GRE images demonstrate a macrolobulated cystic intrasellar and suprasellar mass with fluid-fluid or fluid-debris levels.

CT – Subtle solid component with calcification is seen with wide W/L setting near the posterior right clinoid process.

Craniopharyngiomas are tumors arising from remnants of the craniopharyngeal duct anywhere in the midline from the sphenoid sinus to the sella tursica to the third ventricle. Patients usually present during adolescence but a second peak occurs during the fourth through sixth decades (the lesions tend to be suprasellar in children and intrasellar in adults). Craniopharyngiomas are more common in males. Symptoms include headache and visual changes as in this patient but also hypothalamic-pituitary dysfunction and hydrocephalus can be encountered.

Craniopharyngiomas usually have solid and cystic components but may be predominantly solid or cystic. Size of these lesions varies but larger lesions are usually cystic. Calcification in the cyst wall or solid component is common and aids in the diagnosis of craniopharyngioma. Cyst fluid is rich in cholesterol crystals.

Calcification of the small solid component in this case make the diagnosis difficult. Consequently, epidermoid cyst, arachnoid cyst and juvenile pilocytic astrocytoma could be considered in the differential diagnosis.

Barkovich AJ. Pediatric Neuroimaging, 4th Ed. Lippincott, Williams and Wilkins. 2005.