WHAT IS A WHAT ARE THE PROBLEMS …

1 HOW IS THIS DIAGNOSED ?PituitaryStalkAnteriorLobePosteriorLobe PituitaryFossaPituitaryThird VentricleOptic NerveCarotid ArteryCranio-pharyngiomaWHAT IS ACRANIOPHARYNGIOMA ?WHAT ARE THE PROBLEMS THEY CAUSE ?It is a lesion that grows out of the pituitary fossa. Thepituitary fossa sits above the nose at the back of the eyes andcontains the pituitary gland (see pituitary TUMOUR leaflet).It occurs more frequently in younger patients [less than 20years old] than in older patients. As it grows it presses onimportant structures inside the head and this causes thesymptoms that lead us to the lesion grows upwards and is both cystic and solid [seeillus]. The fluid in the cyst sparkles because it containscrystals of cholesterol. It is felt to grow from the remnant ofan embryological structure called Rathkes pouch.

2 Itcontains calcium in children but may not in GlandCraniopharyngiomagrowing upwardsThere are many ways the tumour causes PROBLEMS :By compressing cells in the pituitary gland and stoppingthem producing the hormones that it normally results in hormone disturbances as these are no longerproduced [see pituitary Tumour leaflet].By pressing on something around the gland as it gets as:1. The nerves to the eyes that control vision and eyemovements. This may result in double vision or loss of partor all of your The part of the brain that directs the pituitary gland andcontrols the balance of fluids in the body [hypothalamus].3. It may block the normal fluid pathways of the brain tocause HYDROCEPHALUS [see Leaflet]. This may resultin drowsiness or headachesInitially this is usually considered from your symptoms.

3 Thehormone levels are checked with blood and urine your pituitary is looked at with a CT and MRI doctor will refer you to a specialist when the diagnosisis considered. You are usually managed byNeurosurgeonEndocrinologistOphthalmolo gistThe pictures from the usually but not always suggestthe diagnosis. The other things that may be considered aretumours of the pituitary gland itself or other This brochure is copyright. No part of it may be repro-duced in any form without prior permission from the brochure is to provide general informa-tion and does not replace a consultation with your YOU NEED SURGERYWHAT WILL IT BE ? NEUROSURGERY PTY LTDACN 082 289 316 PHONE 03 9816 - 9844 FACSIMILE 03 9816 - 9877545 ROYAL PARADEPARKVILLE VIC 3052IS SURGERY ALWAYS NEEDED ?

4 FOR PROCEDURES SEE THERELEVANT PROCEDURE LEAFLETU sually it is as the lesion is found because it is causing aproblem that needs to be fixed. But if the lesion is foundwhile we are looking for something else and is not causingany PROBLEMS then we will probably just observe it withregular FAST DOES IT GROW ?This varies. Not only do different peoples lesions grow atdifferent rates but the growth rate may not be even. Theremay be little growth in the solid part of the lesion butsudden rapid growth or expansion of an associated may cause an acute deterioration in your your surgery even if we know that a small piece is leftit may not show up on MRI. If this has had its bloodsupply removed at the time of surgery it may not continueto the nose/only for lesions isolated to pituitaryglandCRANIOTOMYS mall disc of bone removed to allow access underthe frontal lobe to the lesionVENTRICULO - PERITONEAL SHUNTIf the cyst or surgery has blocked the normal flow ofthe brain fluid ( ) a diversion is neededCYST DRAINAGE (internal or remote)IS IT BENIGN OR MALIGNANT ?

5 It is generally considered a benign tumour in that it doesnot spread to other parts of the body like a malignanttumour does. It does however grow locally and sticks veryhard onto important parts of the brain. This can make itdifficult to treat. It has a tendency to produce cysts andthese may grow quite repeat surgery fails and there is still evidence of growththen radiotherapy will be offered. This slows or stopsgrowth and may reduce the tendency of the craniopharyn-gioma to form will be times that despite all of this the lesioncontinues to grow. At this time you may be offered furthersurgery even if the risks are high if you are developingproblems from the lesions CAN IT BE TREATED ?The aim is to remove it completely if possible. The tumourwill usually recur if there is any left behind.

6 This is donewith an operation. If the lesion is only in the pituitary glandthen the operation may be done via the transphenoidalroute (up the nose) (see leaflet Transphenoidal Removal ofPituitary Lesion). If the tumour extends above this then thesurgery should be via a craniotomy (see leaflet Craniotomyfor pituitary Lesion or Craniopharyngioma). The cran-iotomy is a bigger operation but is needed to visualize thenerves to the eyes and other important structures so that thecyst membrane can be completely removed. If the CT/MRIscan does not clearly show the type of tumour it may onlybe presumed to be a Craniopharyngioma prior to surgery (hopefully it can be completely removed) wewill watch the area concerned with regular imaging (CT orMRI) to see if there is any recurrence. Initially this will bedone at 3 months then at 6 months and then at about 1year.

7 While it shows no evidence of recurrence we slowlyincrease the time between images. If there is known to besome left after surgery we will watch you closely. If it growsand starts causing PROBLEMS again then surgery is the firstoption. It is more difficult the second time but is still thetreatment of choice and a cure can still be achieved at patients require frequent operations to control thegrowth and other therapy is only offered if we feel that therisks of further surgery are too SINUSRETRACTORL ocation of lesion inside the headandTransphenoidal Approach