Childhood Craniopharyngioma Treatment (PDQ®)–Patient Version

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General Information About Childhood Craniopharyngioma

KEY POINTS

Childhood craniopharyngiomas are benign brain tumors found near the pituitary gland.
There are no known risk factors for childhood craniopharyngioma.
Signs of childhood craniopharyngioma include vision changes and slow growth.
Tests that examine the brain, vision, and hormone levels are used to detect (find) childhood craniopharyngiomas.
Childhood craniopharyngiomas are diagnosed and may be removed in the same surgery.
Certain factors affect prognosis (chance of recovery) and treatment options.

Childhood craniopharyngiomas are benign brain tumors found near the pituitary gland.

Childhood craniopharyngiomas are rare tumors usually found near the pituitary gland (a pea-sized organ at the bottom of the brain that controls other glands) and the hypothalamus (a small cone-shaped organ connected to the pituitary gland by nerves).

Drawing of the inside of the brain showing ventricles (fluid-filled spaces), choroid plexus, hypothalamus, pineal gland, pituitary gland, optic nerve, brain stem, cerebellum, cerebrum, medulla, pons, and spinal cord. — Anatomy of the inside of the brain, showing the pineal and pituitary glands, optic nerve, ventricles (with cerebrospinal fluid shown in blue), and other parts of the brain.

Craniopharyngiomas are usually part solid mass and part fluid -filled cyst. They are benign(not cancer) and do not spread to other parts of the brain or to other parts of the body. However, they may grow and press on nearby parts of the brain or other areas, including the pituitary gland, the optic chiasm, optic nerves, and fluid-filled spaces in the brain. Craniopharyngiomas may affect many functions of the brain. They may affect hormonemaking, growth, and vision. Benign brain tumors need treatment.

This summary is about the treatment of primary brain tumors (tumors that begin in the brain). Treatment for metastatic brain tumors, which are tumors formed by cancer cellsthat begin in other parts of the body and spread to the brain, is not covered in this summary. See the PDQ treatment summary on Childhood Brain and Spinal Cord Tumors Treatment Overview for information about the different types of childhood brain and spinal cord tumors.

Brain tumors can occur in both children and adults; however, treatment for children may be different than treatment for adults. (See the PDQ summary on Adult Central Nervous System Tumors Treatment for more information.)

There are no known risk factors for childhood craniopharyngioma.

Craniopharyngiomas are rare in children younger than 2 years of age and are most often diagnosed in children aged 5 to 14 years. It is not known what causes these tumors.

Signs of childhood craniopharyngioma include vision changes and slow growth.

These and other signs and symptoms may be caused by craniopharyngiomas or by other conditions. Check with your child’s doctor if your child has any of the following:

Headaches, including morning headache or headache that goes away after vomiting.
Vision changes.
Nausea and vomiting.
Loss of balance or trouble walking.
Increase in thirst or urination.
Unusual sleepiness or change in energy level.
Changes in personality or behavior.
Short stature or slow growth.
Hearing loss.
Weight gain.

Tests that examine the brain, vision, and hormone levels are used to detect (find) childhood craniopharyngiomas.

The following tests and procedures may be used:

Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
Neurological exam : A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a person’s mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam.
Visual field exam: An exam to check a person’s field of vision (the total area in which objects can be seen). This test measures both central vision (how much a person can see when looking straight ahead) and peripheral vision (how much a person can see in all other directions while staring straight ahead). Any loss of vision may be a sign of a tumor that has damaged or pressed on the parts of the brain that affect eyesight.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
MRI (magnetic resonance imaging) of the brain and spinal cord with gadolinium : A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain. A substance called gadolinium is injected into a vein. The gadolinium collects around the tumor cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
Blood hormone studies: A procedure in which a blood sample is checked to measure the amounts of certain hormones released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it. For example, the blood may be checked for unusual levels of thyroid-stimulating hormone (TSH) or adrenocorticotropic hormone (ACTH). TSH and ACTH are made by the pituitary gland in the brain.

Childhood craniopharyngiomas are diagnosed and may be removed in the same surgery.

Doctors may think a mass is a craniopharyngioma based on where it is in the brain and how it looks on a CT scan or MRI. In order to be sure, a sample of tissue is needed.

One of the following types of biopsy procedures may be used to take the sample of tissue:

Open biopsy: A hollow needle is inserted through a hole in the skull into the brain.
Computer-guided needle biopsy: A hollow needle guided by a computer is inserted through a small hole in the skull into the brain.
Transsphenoidal biopsy: Instruments are inserted through the nose and sphenoidbone (a butterfly-shaped bone at the base of the skull) and into the brain.

A pathologist views the tissue under a microscope to look for tumor cells. If tumor cells are found, as much tumor as safely possible may be removed during the same surgery.

The following laboratory test may be done on the sample of tissue that is removed:

Immunohistochemistry : A test that uses antibodies to check for certain antigens in a sample of tissue. The antibody is usually linked to a radioactive substance or a dye that causes the tissue to light up under a microscope. This type of test may be used to tell the difference between different types of cancer.