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How to Treat Childhood Craniopharyngioma

What is a craniopharyngioma?

Craniophyryngioma is usually a benign tumor that occurs in children early in their age and is located near the pituitary gland and the hypothalamus. The growth is usually detected between the ages of 5 – 14 years of age while these children can present in many different ways according to the extent and the spread of the tumor.

What are its clinical presentations?

As the tumor grows near to the pituitary, optic chiasma, ventricular spaces…etc, these children can present with visual disturbances, headache, nausea, vomiting, poor balance and coordination during walking, excessive sleepiness, hormonal deprivation such as short stature, poor growth, behavioral abnormalities…etc. The diagnosis would be initiated through physical examinations that elicit there is a defective neurological functions or hormonal imbalance and would proceed to more advanced imaging and biochemical studies. The modern imaging studies would be able to accurately pin point the location and the size of the tumor and if in a accessible place, it can be removed surgically for both diagnostic purposes as in a biopsy as well as for treatment.

How is it treated?

The option to remove the cancer would be taken with the consultation of a team of consultants which will include neurologists, surgeons, radiologists as well as other relevant clinicians.

At the most basic diagnostic intervention, a needle can be introduced to the site of the tumor and part of it aspirated to assess the presence of malignant cells in the aspirate. The procedure can be done through an open method in which the needle is inserted through a hole made in the skull bone or else under the CT guidance for pin point accuracy at times of difficult locations. Another approach used by the surgeons is to insert the needle through the sphenoid bone while going through the nasal cavity.

Another method of management would be a so called ‘stereotactic radiosurgery’ or ‘fractionate stereotactic radiosurgery’. These methods are used in specialized centers for complex forms of the craniopharyngiomas. In this method, following determining whether the tumor can be completely excised or not, the surgeons will recommend the use of radiotherapy to reduce any remaining cancer cell. This would be used more often in case the tumor is diagnosed to have cancerous potential.

Lastly, following undergoing surgical procedures, if the histology returns as invasive cancer, a bout of chemotherapy may also be tried as it can kill the remaining cancer cells to a great extent. But, it should be remembered that, in most instances, diagnostic biopsy would be the only intervention that is required for managing these conditions.