Craniopharyngioma: Symptoms, Causes, Diagnosis, and Treatment

Summary

Dr. Aaron Cohen Gadol discusses craniopharyngiomas, a rare, benign brain tumor near the pituitary gland. He outlines symptoms like headaches and vision problems, common in children and older adults. Treatment options include observation, radiation, and surgery, with the latter often requiring a balance between removal and preserving gland function. Despite potential complications and recurrence, survival rates are high, emphasizing the importance of an experienced surgeon for optimal outcomes.

Takeaways

• 🧠 Craniopharyngiomas are benign, slow-growing brain tumors typically occurring near the pituitary gland and hypothalamus.
• 🏥 These tumors can compress surrounding structures like the optic nerve, affecting vision, but they are not cancerous.
• 📈 Incidence is rare, affecting less than two people per one million per year, with two age peaks: children aged 5-14 and adults aged 50-70.
• 🔬 Key terminologies include 'pituitary gland', a hormone-producing gland, and 'hormone', which controls cell or tissue actions.
• 🤒 Typical symptoms include headaches, vomiting, visual problems, and less commonly, confusion, excessive thirst, fatigue, and cognitive issues.
• 📊 Diagnostic tests include CT scans for calcifications and MRI for tumor differentiation from surrounding tissues.
• 🛠️ Treatment options encompass observation, radiation, and surgical resection, often requiring a combination for effective management.
• ⚕️ Surgical resection is primary but complex due to the tumor's adhesive nature; complete removal may require hormone replacement.
• ⚠️ Surgical complications can include vision deterioration, hormonal imbalances, excessive thirst or urination, and optic neuropathy.
• 👨‍⚕️ The experience of the surgeon is critical for a favorable outcome, with maximal safe tumor removal as the goal.
• 🔄 Recurrence is possible in nearly a third of cases but can be managed with additional therapies, including radiation.
• 💯 Prognosis is favorable, with 90% of adults and children alive and functional at 10 years post-treatment.

Q & A

What is a craniopharyngioma?

A craniopharyngioma is a benign, slow-growing brain tumor that typically occurs near the pituitary gland and the hypothalamus, often compressing surrounding structures like the optic nerve.

Is a craniopharyngioma a type of cancer?

No, a craniopharyngioma is not a cancer. It is a benign tumor, meaning it is not cancerous and does not spread to other parts of the body.

How common are craniopharyngiomas?

Craniopharyngiomas are rare, affecting less than two people per one million people per year and accounting for about 1-3% of all brain tumors.

What are the two age peaks for the occurrence of craniopharyngiomas?

The two age peaks for the occurrence of craniopharyngiomas are in children between the ages of 5 to 14 and older adults between the ages of 50 to 70.

What is the role of the pituitary gland in relation to craniopharyngiomas?

The pituitary gland is closely associated with craniopharyngiomas. It is a small, bean-shaped gland at the base of the skull that produces hormones critical for body function, such as growth hormones.

What are the typical symptoms of a craniopharyngioma?

The typical symptoms of a craniopharyngioma include headache, vomiting, and visual problems. Less common symptoms can include confusion, extreme thirst or urination, feeling tired, loss of appetite, weight changes, and problems with thinking or learning.

What diagnostic tests are used to identify craniopharyngiomas?

Diagnostic tests for craniopharyngiomas include CT scans, which can identify calcifications within the gland, and MRI, which can differentiate the tumors from surrounding soft tissues and identify cysts filled with fluid.

What are the treatment options for craniopharyngiomas?

Treatment options for craniopharyngiomas include observation, radiation, and surgical resection. Surgical resection is the primary mode of treatment, but most patients may require a combination of these options.

What is radiosurgery and how is it used in treating craniopharyngiomas?

Radiosurgery is a treatment that uses concentrated beams of radiation aimed at the tumor while protecting the surrounding vital structures. It is particularly effective for recurrent tumors or tumors that cannot be easily or safely removed via surgery.

What are some potential complications of surgery for craniopharyngiomas?

Potential complications of surgery for craniopharyngiomas include vision deterioration, hormonal abnormalities due to injury to the pituitary gland, excessive thirst or urination, leakage of brain fluid through the nose, hyperphagia, and radiation-induced optic neuropathy.

What is the most common surgical approach for removing craniopharyngiomas?

The most common surgical approach for removing craniopharyngiomas is through the nose using a transvenor operation, which provides the most effective and least invasive pathway to remove the tumor.

What is the long-term outlook for patients with craniopharyngiomas?

The long-term outlook for patients with craniopharyngiomas is favorable, with a survival rate of 90% for both adults and children at 10 years. However, nearly a third of the tumors can recur and may require additional treatment.

Outlines

00:00

🧠 Understanding Craniopharyngiomas: A Neurosurgeon's Perspective

Dr. Aaron Cohen Gadol, a neurosurgeon with extensive experience in managing chronic craniopharyngiomas, introduces the topic and provides an overview of these benign, slow-growing brain tumors. He clarifies that they are not cancerous and typically occur near the pituitary gland and hypothalamus, potentially affecting vision. The tumors' sticky nature makes complete resection challenging, leading to recurrence. They are rare, affecting less than two people per million annually, with symptoms more common in children aged 5-14 and adults aged 50-70. Key terminologies include the pituitary gland, a hormone-producing gland, and hormones, like growth hormones, which are critical for body functions.

05:02

🛠️ Treatment and Management of Craniopharyngiomas

The script continues with an in-depth discussion on the diagnosis and treatment options for craniopharyngiomas. Initial tests include CT scans to identify calcifications and MRIs to differentiate the tumor from surrounding tissues. Treatment options range from observation for small, asymptomatic tumors to surgical resection, which is the primary mode of treatment but may require a combination of approaches due to the tumor's complex nature. Surgical resection aims for maximal tumor removal, but complete removal may necessitate sacrificing the pituitary gland function, leading to lifelong hormone replacement. Complications of surgery can include vision deterioration, hormonal abnormalities, excessive thirst or urination, leakage of brain fluid, hyperphagia, and radiation-induced optic neuropathy. The most common surgical approach is the transvenor operation through the nose. The patient's journey involves lifelong management, with nearly a third of tumors recurring but being treatable with other therapies. The survival rate is high, with 90% of adults and children alive and functional after 10 years. Dr. Cohen Gadol emphasizes the importance of the surgeon's experience for a favorable outcome and offers his expertise for second opinions.

Keywords

💡Neurosurgeon

A neurosurgeon is a specialized physician who performs surgery on the brain and nervous system. In the context of the video, Aaron Cohen Gadol, the speaker, is a neurosurgeon with experience in managing patients with chronic pharyngeal tumors. This role is central to the video's theme as the neurosurgeon provides insights into the diagnosis, treatment, and management of these specific brain tumors.

💡Chronic Pharyngeal Tumor

A chronic pharyngeal tumor, also known as craniopharyngioma, is a benign, slow-growing brain tumor typically occurring near the pituitary gland and hypothalamus. The video's focus is on this type of tumor, discussing its characteristics, symptoms, and treatment options. It is important to note that it is not cancerous, which is a key point in the video's message to reassure patients.

💡Pituitary Gland

The pituitary gland is a small, bean-shaped gland located at the base of the skull that produces hormones critical for body function, including growth hormones. In the video, the pituitary gland is closely associated with chronic pharyngeal tumors, which can affect its function and lead to hormonal imbalances, illustrating the gland's relevance to the video's theme.

💡Hormone

Hormones are chemical substances in the body that regulate the actions of cells or tissues. The video explains that chronic pharyngeal tumors can impact the pituitary gland's hormone production, which is vital for various bodily functions. The term 'hormone' is used to describe the substances affected by these tumors, linking it directly to the video's discussion on the effects of the tumor on the body.

💡Symptoms

The video lists several symptoms associated with chronic pharyngeal tumors, such as headaches, vomiting, and visual problems. These symptoms are crucial for understanding the patient's experience and the challenges they face due to the tumor. The script uses these symptoms to highlight the impact of the tumor on daily life and the importance of diagnosis and treatment.

💡CT Scan

A CT scan, or computed tomography, is a medical imaging technique that the video mentions as a diagnostic tool for identifying calcifications within the gland, which can be indicative of a craniopharyngioma. The CT scan is integral to the diagnostic process discussed in the video, helping to confirm the presence of the tumor.

💡MRI

MRI, or magnetic resonance imaging, is another diagnostic tool highlighted in the video. It is used to differentiate tumors from surrounding soft tissues and identify characteristics such as cysts filled with fluid. The MRI is essential in the video's narrative for its role in accurately diagnosing and understanding the nature of the tumor.

💡Radiosurgery

Radiosurgery is a treatment option discussed in the video, which involves concentrated beams of radiation aimed at the tumor while protecting surrounding structures. It is presented as an effective treatment for recurrent tumors or those not easily removable by surgery, illustrating the video's exploration of various therapeutic approaches.

💡Fractionated Radiotherapy

Fractionated radiotherapy is another radiotherapy method mentioned in the video, where smaller doses of radiation are administered over several visits. This approach takes longer for the radiation to take effect, and it is used as an alternative or adjunct to other treatments, showcasing the video's comprehensive coverage of treatment options.

💡Surgical Resection

Surgical resection is the primary mode of treatment for chronic pharyngeal tumors as discussed in the video. It involves the removal of the tumor wholly or partially by an experienced surgeon. The video emphasizes the importance of maximal tumor removal safely, highlighting the surgical aspect of managing these tumors.

💡Complications

The video outlines potential complications related to the surgery for chronic pharyngeal tumors, including vision deterioration, hormonal abnormalities, excessive thirst or urination, leakage of brain fluid, and radiation-induced optic neuropathy. These complications are crucial for understanding the risks involved in treatment and the ongoing care required by patients.

Highlights

Introduction to the topic by neurosurgeon Aaron Cohen-Gadol, focusing on chronic craniopharyngiomas.

Definition of craniopharyngiomas as benign and slow-growing brain tumors, typically near the pituitary gland and hypothalamus.

Craniopharyngiomas can compress surrounding structures such as the optic nerve, affecting vision.

Despite being benign, the tumors are sticky to normal structures, making complete resection challenging.

Craniopharyngiomas are rare, affecting less than two people per million annually and accounting for about 1-3% of all brain tumors.

The tumors are most commonly seen in children aged 5-14 and older adults aged 50-70.

Explanation of key terminologies: the pituitary gland and hormones, particularly growth hormones.

Typical symptoms of craniopharyngiomas include headaches, vomiting, and visual problems, with less common symptoms being confusion, extreme thirst or urination, and slow growth.

Diagnostic tests include CT scans for detecting calcifications and MRIs for detailed imaging of the tumor and surrounding tissues.

Treatment options: observation, radiation, and surgical resection, with surgery being the primary mode of treatment.

Observation is recommended for small, asymptomatic tumors, with regular MRI follow-ups.

Radiosurgery and fractionated radiotherapy are alternatives for recurrent or non-removable tumors, with details on each method's process and effectiveness.

Surgical resection aims to remove as much of the tumor as safely possible, with complete removal sometimes requiring hormone replacement for life.

Potential complications from surgery include vision deterioration, hormonal abnormalities, and excessive thirst or urination.

The most common surgical approach is the transsphenoidal operation, providing an effective and minimally invasive pathway for tumor removal.

Craniopharyngiomas are chronic conditions requiring lifelong treatment, with up to a third of tumors potentially recurring.

Despite the challenges, survival rates are favorable, with 90% of patients being alive and functional at 10 years.

Emphasis on the importance of the surgeon's experience for a favorable outcome and safe maximal tumor removal.

Encouragement for patients to seek a second opinion consultation if needed.

Transcripts

[Music]

hello ladies and gentlemen my name is

aaron cohen gadol i'm a neurosurgeon

i've been involved in the management of

patients suffering from chronic friend

jomos for many years and today i'd like

to talk to you about the information

that is important for the journey of the

patients after they have been diagnosed

with this tumor type

so what is a chronic pharyngeal it's a

brain tumor that

is benign and slow growing that's very

important this tumor is not a cancer

and it occurs typically near the

pituitary gland and the hypothalamus in

other words at the level of the skull

base it can compress the surrounding

structures such as the optic nerve in

other words the vision nerve that takes

information from the eyes to the brain

and effect

visualization

of things every day

also because they're sticky to the

normal structures complex resection

unfortunately is not possible and

therefore these tumors tend to occur and

that tends to be the most challenging

detail under management

fortunately these tumors are rare they

affect less than two people per

one million people per year they account

for about one to two one to three

percent of all brain tumors

and the symptoms are more commonly seen

in children between the age of 5 to 14

and older adults in the age of 50 to 70.

so there are two peaks of age for this

tumor type there is a couple of

terminologies that are very important

for patients who have been diagnosed

with a chronic pharyngeal the first

terminology is a pituitary gland it is a

gland that is very much

involved with these tumors and closely

associated the pituitary gland is a

small bean shaped gland at the level of

the skull base

that produces hormones that are very

critical for body function such as

growth hormones

and the second terminology is what is a

hormone it's a chemical substance such a

growth such as a growth hormone that

helps controls actions of cells or

tissues in the body

and more specifically for the growth

hormone would be controlling the growth

so what are the typical symptoms related

to chronic pharyngeals number one is

headache vomiting or visual problems

these are the top three problems that

can be associated with a

cranipharyngeoma

there are other less common symptoms

such as confusion extreme thirst or

urination feeling tired loss of appetite

weight changes problems with thinking or

learning and slow growth

or

other related

problems

what are the tests that we typically use

the first test is using a ct scan or a

computer tomography where we can see the

calcifications within the gland and

obviously very importantly an mri

magnetic resonance imaging where the

tumors are easily differentiated from

the surrounding soft tissues

and their character in terms of having

cysts filled with fluid are found

but typically in this area

presence of calcification of ct scan and

cysts in the tumor

signifies the presence of a

craniopharyngioma

relative to a typical pituitary tumor

what are the options for treatment

observation radiation and

surgical resection surgical resection is

the primary mode of treatment

however at the end

most

of the patient require

three of these options in some form

uh to treat the tumor most effectively

so when we start

with observation this is

for tumors that are relatively small

they're asymptomatic

and these tumors can be observed and

obviously every six months or a year mri

is performed to make sure the tumor is

not growing

also radiosurgery may be an option for

these tumors that is most effective

for recurrent tumors or tumors that

cannot be removed

easily via surgery

or safely

what is radiosurgery is concentrated

beams of radiation that are aimed

at the tumor while preserving and

protecting the surrounding vital

structures it takes this takes about 30

to 50 minutes and the patients go home

same day

also there is another form of

radiotherapy called fractionated

radiotherapy this is smaller dose of

radiation that are aimed at the tumor

over several visits up to

you know a month of treatment

and it takes up to 18 months

or more for the radiation to take effect

and stop the growth of the tumor

when we talk about surgery

the surgeon tries to remove as much of

the tumor wholly or partially

the more the tumor is removed the better

it is obviously it requires an

experienced surgeon to be able to remove

as much of the tumor as safely as

possible

partial removal again is for those

situations where the tumor is very stuck

to the vessels or the pituitary gland

itself

complete removal is possible but may

require sacrificing the pituitary gland

function and hormone replacement for the

rest of life

what are the complications related to

surgery it could be vision deterioration

hormonal abnormalities due to

injury to the pituitary gland because

this tumor typically arises and is very

much associated with the stock of the

pituitary gland which

controls the functions of the pituitary

gland

excessive thirst or urination can be

long-term complications related to the

failure of the pituitary gland

leakage of brain fluid through the nose

and strong sensation of hunger

hyperphagia in other words especially

among the children who undergo this

procedure and also radiation induced

optic neuropathy in other words

injury to the optic nerve because of

radiation can be another complication

related to this tumor

the most common approach for removal of

the tumor is through the nose through a

transvenor operation

because this provides the most effective

pathway and least invasive to be able to

remove this tumor

so

what's important to know about chronic

pharyngeal pharyngeals that are cru they

are chronic conditions in other words

the patient require some sort of

treatment for the rest of their life

in terms of radiation treatment or

hormonal therapy to be able to manage

their treatment very effectively

unfortunately nearly up to a third of

tumor can recur but can be treated with

other modes of therapy including

radiation

survival is very favorable with 90 of

the adults and children alive and

functional at 10 years so overall as a

patient i would like you to know

that these tumors are not cancerous very

effective therapies exist

experience of the surgeon is critical

for favorable outcome a maximal tumor

removal

safely it has been an honor for me for

the past 20 years to be involved with

the care of many of patients suffering

from this tumor type and i'll be more

than happy to provide you with a second

consult second opinion consultation if

needed thank you

[Music]