eMedicine Specialties > Neurology > Neuro-oncology

Craniopharyngioma: Treatment & Medication

Author: George C Bobustuc, MD, Consulting Staff, Department of Neuro-Oncology, MD Anderson Cancer Center Orlando
Coauthor(s): Morris D Groves, MD, Assistant Professor, Department of Neuro-Oncology, MD Anderson Cancer Center, University of Texas; Gregory N Fuller, MD, PhD, Professor of Pathology, Chief, Section of Neuropathology, Department of Pathology, Division of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center; Franco DeMonte, MD, FRCSC, FACS, Professor of Neurosurgery, Mary Beth Pawelek Chair in Neurosurgery, The University of Texas, MD Anderson Cancer Center, Houston Texas
Contributor Information and Disclosures

Updated: Sep 4, 2009

Treatment

Medical Care

Essentially, 2 main management options are available for craniopharyngioma—(1) attempt at gross total resection or (2) planned limited surgery followed by radiotherapy.

  • Although no consensus exists on the various therapeutic modalities for craniopharyngiomas, most authors advocate that successful management is determined by the ability to maintain independent social functioning, symptomatic recurrence, and survival.
    • Neuropsychological deficits represent the major limiting factor of independent social functioning because (1) patients often can overcome minor neurological deficits and (2) hormone-repleting therapies are widely available. Degree of psychosocial impairment correlates directly with the degree of hypothalamic injury sustained at the time of surgery.
    • Systemic chemotherapy has been tried but to no avail.
    • New systemic biologic therapies are currently under investigation with interesting results (eg, interferon alpha-2a for progressive or recurrent craniopharyngiomas).

Surgical Care

Gross total surgical removal is the treatment of choice; however, it can be associated with morbidity and mortality rates as high as 20% (excluding endocrinopathies) and 12%, respectively. Recurrence rates can be as high as 20%; a serious potential for psychosocial deficits exists in patients with hypothalamic injury.

  • The surgical approaches for resection of craniopharyngioma include the standard pterional approach, the orbitocranial approaches, as well as the subfrontal, transsphenoidal, and transcallosal approaches. At times, a combination of approaches is necessary.
    • Perioperative morbidity includes (1) seizures, (2) visual deficits including blindness, (3) hypothalamic injury, (4) stroke, and (5) CSF leakage.
    • Endocrinopathy is common. Permanent diabetes insipidus occurs in 68-75% of adults and 80-93% of children. Replacement of 2 or more of the anterior pituitary hormones is necessary in 80-90% patients. Obesity occurs in 50% of patients.
    • Recurrence/progression following failed gross total or subtotal resection is common and occurs in 75% of patients. Recurrence usually is identified 2-5 years following resection.
  • Some authors propose a plan of limited surgery, with postoperative radiotherapy as the management paradigm of choice for craniopharyngioma. Goals of this approach are (1) pathologic confirmation of the tumor and (2) surgical decompression of the optic chiasma. Surgery is followed by external beam radiation, at a dose of 5400-5500 cGy delivered at 180 cGy/fraction.
    • The incidence of tumor progression after planned limited surgery and radiotherapy ranges from 12-25% and is similar to that seen with failed gross total resection and radiotherapy (4-25%).
    • Radiotherapy delivered at recurrence (salvage radiotherapy) is effective, with posttreatment progression rates of 29%. Recurrence following radiotherapy has been associated with a 50-80% mortality rate.
  • Thus, the optimal approach should consider total removal safe (ie, no hypothalamic injury) or otherwise combine a subtotal resection (ie, removal of as much tumor as possible with no hypothalamic injury) with postoperative radiotherapy.
  • For selected patients with suprasellar craniopharyngiomas, an endonasal extended endoscopic approach could provide a viable alternative to transcranial approaches.14,15
  • Other approaches that can be useful in the management of giant craniopharyngioma, especially at the time of recurrence, include (1) intermittent aspiration by stereotactic puncture or Ommaya reservoir placement, (2) intracystic injection of bleomycin,16 or (3) internal irradiation with radioisotopes. The latter 2 treatment modalities have been reported to control the tumor cysts in 90-100% of cases. In general, the 10-year survival rate for craniopharyngiomas is 90% and the 20-year survival rate for pediatric craniopharyngiomas is approximately 60%.

Medication

Agents/modalities used in the treatment of craniopharyngioma include (1) bleomycin for local intracystic chemotherapy17,18,19 and (2) radiation therapy applied as external fractionated radiation, stereotactic radiation, or brachytherapy (intracavitary irradiation).20,21,22,23,24

Chemotherapeutic agents

In combination with other drugs, these are used frequently and systemically against epithelial tumors. In the early 1970s, bleomycin was found to have encouraging results in controlling craniopharyngioma tissue in cultures. Intracavitary bleomycin reduces cyst size and toughens and thickens the cyst wall, thereby facilitating surgical excision of a cyst membrane that otherwise might fragment at the time of open craniotomy. However, reports of intracystic bleomycin use are limited.


Bleomycin (Blenoxane)

Group of glycopeptides extracted from Streptomyces species. Each molecule has a planar end and an amine end; different glycopeptides of the group differ in their terminal amine moieties. Planar end intercalates with DNA, while amine end facilitates oxidation of bound ferrous ions to ferric ions, thereby generating free radicals, which subsequently cleave DNA, acting specifically at purine-G-C-pyrimidine sequences.
Not absorbed when given orally; peak levels reached in about 30-60 min when given IM and are only one third of levels obtained after IV administration; approximately 50% of drug absorbed systemically after intrapleural or intraperitoneal administration; systemic absorption after intracavitary administration for craniopharyngioma not negligible.
Volume of distribution is 20-30 L both in intracellular and extracellular fluid.
Less than 10% is bound to plasma proteins.
Bleomycin has plasma half-life of less than 1 h and terminal half-life of 2-4 h, but it could be as long as 22 h in patients with renal dysfunction or those previously treated with cisplatin.
About 50% eliminated in urine within 24 h. Most tissues (known exceptions—skin and lungs) contain an enzyme, bleomycin hydrolase (most active tissues are liver and kidney), which readily inactivates drug; therefore, toxicity is tissue specific, occurring in tissues lacking this enzyme. Bleomycin mostly used systemically in combination with other drugs (mostly with cisplatin and vincristine) for treatment of testicular carcinoma, Hodgkin lymphoma, and non-Hodgkin lymphoma; squamous cell carcinoma of skin, head and neck, and cervix; and malignant pleural effusions.
Principal mechanisms of resistance include high levels of bleomycin hydrolase, cell mutations altering DNA sequences to prevent intercalation, poor cell accumulation of drug, and rapid plasma removal. None of these factors plays important role when bleomycin administered locally in residual cyst.
Toxicity is age dependent and cumulative dose related; systemic administration mostly causes pulmonary toxicity. This consists of pneumonitis, which can progress to fatal pulmonary fibrosis.
Maximum recommended total cumulative dose for systemic use is 400 U. Unit measurement based on toxicity to bacteria; 1 U equals approximately 1.7 mg.
Administered systemically, does not produce significant bone marrow toxicity. Toxicity with local administration due to both systemic contamination (when anaphylactoid reactions, transient fever, nausea, and vomiting could occur) and leakage into surrounding neural tissue. Fatal outcome has been reported with leakage, due to subsequent diffuse diencephalon and brainstem edema. Others report transient local toxicity with leakage into the surrounding brain reversed by high-dose steroid use.
Contrast CT cystography is required prior to intracavitary administration to ensure cyst wall integrity; when inconclusive, MR cystography with gadopentetate dimeglumine has been advocated.

Adult

For local administration in residual cyst, dose depends on cyst volume, and repeated administrations are usually required
Varying dosages in repeated administrations intracavitary to a total cumulative dose of 40-80 mg over 7-21 days or longer intervals of 5- 10 weeks were reported, done with a frequency of 3 times/week with 3-5 mg intracystic/dose initially for first 5 weeks and followed by weekly administrations for another 5 weeks.
Lower dose per treatment session may help avert a fatal outcome in the rare case when leakage occurs into the surrounding brain.

Pediatric

Not established

Phenothiazine may enhance cytotoxicity; cisplatin decreases elimination, thereby enhancing toxicity; radiation and hyperoxia may increase pulmonary toxicity; hydrogen peroxide and ascorbic acid inactivate bleomycin

Documented hypersensitivity; significant renal function impairment; compromised pulmonary function

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Intracavitary administration requires prior contrast CT cystography to ensure cyst wall integrity; when inconclusive, MR cystography with gadopentetate dimeglumine has been advocated

Radiation

Radiation creates free oxygen ions that damage cellular DNA. Cellular ability to repair DNA is lower for tumor cells than normal cells and subsequently, with each mitosis, a higher cumulative effect in tumor cells results in apoptosis.


External fractionated radiation

Offers dual advantage by (1) allotting normal cells more time for repair and (2) amplifying higher cumulative effect of DNA damage in more rapidly dividing tumor cells.
Radiation, following partial resection, offers excellent long-term results (80% at 20 years). Following partial resection, results of primary irradiation are superior to those with radiation delayed until time of recurrence. Recurrence is less frequent after imaging confirmed total resection (10-30% recurrence rate), in which case radiation should be delayed.

Adult

Target volume for craniopharyngioma is narrowly confined to tumor volume (preoperative volume plus 1.5-cm margin) and should include solid component and cyst(s); should be limited to postoperative residual tumor in case of partial resection of large (multi) cystic craniopharyngioma, with special attention to cover cyst wall; high-energy photons are used with 2-3 stationary fields or classic coronal arc configuration
Radiotherapy target dose should be 54-56 Gy over 30 sessions (over 6 wk; Monday-Friday weekly schedule), at 1.8-2 Gy/session (ie, per day)
Dose <54 Gy has been associated with high recurrence rate (about 50%) while doses of 54 Gy or more associated with recurrence rate of only 15%
Dose >60 Gy associated with marked increase in radiologic-induced endocrine, neurologic, and vascular complications

Pediatric

Not established

Imaging confirmed total resection (10-30% recurrence rate)

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Fetal exposure is <0.1 Gy (0.04-0.09% of tumor dose) at usual doses (50-68 Gy) used for brain irradiation; this confers increased (but acceptable) risk of leukemia in children, with no deleterious effects to fetus after fourth week of gestation
Radiotherapy should be avoided completely in children <3-4 y
Complications of radiotherapy include intellectual decline, radiation-induced necrosis, optic neuropathy, pituitary-hypothalamic damage, secondary malignant brain tumors; vascular abnormalities that occasionally lead to vasospasm; self-limiting, mostly asymptomatic, hemorrhages; less commonly, proximal irradiation of carotid arteries leads to development of Moyamoya disease


Brachytherapy/radioisotopes

Recommended for solitary cystic craniopharyngiomas and consists of stereotactic aspiration of cystic content, followed by instillation of beta-emitting isotope (eg, phosphorus 32, rhenium 186, gold 198, yttrium 90).
Brachytherapy is attractive because about 60% of craniopharyngiomas occur as single large cysts; early refilling is the rule, requiring intermittent aspiration either by stereotactic puncture or Ommaya reservoir.
Stereotactic radiation has been used for further treatment of residual solid tumor after brachytherapy.

Adult

Target radiation dose 200-250 Gy, aimed at inner surface of cyst wall, which is far higher than dose that can be administered safely with external beam radiation
Maximum range of beta particles from phosphorous 32 in soft tissue is approximately 8 mm; more than half the dose absorbed by first 1.5 mm of tissue, which allows ablation of secretory cells within cyst wall without significant irradiation of surrounding brain tissue
Brachytherapy offers both (1) advantage of high reduction in dose to normal surrounding tissues (eg, optic chiasma, hypothalamus) and (2) an option for patients who received prior external beam radiation; brachytherapy usually results in stabilization or reduction of cyst in >90% of cases

Pediatric

Not established

Imaging confirmed total resection (10-30% recurrence rate)

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Acute inflammatory reactions reported following brachytherapy (some authors have advocated routine use of steroids)


Stereotactic radiation

Has been used primarily as first-line for treatment of growing or symptomatic, solid, small (sized) size craniopharyngioma (<25-30 mm in diameter). Stabilization or reduction of cystic cavity after radiosurgery achieved in more than 60% of patients.

Adult

High-dose volume should be limited to well-circumscribed tumor; safety margin of at least 3-5 mm from optic nerve recommended

Pediatric

Not established

Imaging confirmed total resection (10-30% recurrence rate)

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Major complications include visual impairment; >30% of patients experience severe visual deterioration; <10% of patients show rapid visual loss
Fetal exposure is <0.1 Gy (0.04-0.09% of tumor dose) at usual doses (50-68 Gy) used for brain irradiation, which confers increased but acceptable risk of leukemia in children; no deleterious effects to fetus after fourth week of gestation reported

More on Craniopharyngioma

Overview: Craniopharyngioma
Differential Diagnoses & Workup: Craniopharyngioma
Treatment & Medication: Craniopharyngioma
Follow-up: Craniopharyngioma
Multimedia: Craniopharyngioma
References
Further Reading
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References

  1. Mori M, Takeshima H, Kuratsu J. Expression of interleukin-6 in human craniopharyngiomas: a possible inducerof tumor-associated inflammation. Int J Mol Med. Oct 2004;14(4):505-9. [Medline].

  2. Cavalheiro S, Dastoli PA, Silva NS, et al. Use of interferon alpha in intratumoral chemotherapy for cystic craniopharyngioma. Childs Nerv Syst. Aug 2005;21(8-9):719-24. [Medline].

  3. Gupta DK, Ojha BK, Sarkar C, Mahapatra AK, Mehta VS. Recurrence in craniopharyngiomas: analysis of clinical and histological features. J Clin Neurosci. May 2006;13(4):438-42. [Medline].

  4. Rickert CH, Paulus W. Lack of chromosomal imbalances in adamantinomatous and papillary craniopharyngiomas. J Neurol Neurosurg Psychiatry. Feb 2003;74(2):260-1. [Medline].

  5. Rienstein S, Adams EF, Pilzer D, et al. Comparative genomic hybridization analysis of craniopharyngiomas. J Neurosurg. Jan 2003;98(1):162-4. [Medline].

  6. Oikonomou E, Barreto DC, Soares B, et al. Beta-catenin mutations in craniopharyngiomas and pituitary adenomas. J Neurooncol. Jul 2005;73(3):205-9. [Medline].

  7. Sekine S, Shibata T, Kokubu A. Craniopharyngiomas of adamantinomatous type harbor beta-catenin gene mutations. Am J Pathol. Dec 2002;161(6):1997-2001. [Medline].

  8. Sekine S, Takata T, Shibata T, et al. Expression of enamel proteins and LEF1 in adamantinomatous craniopharyngioma:evidence for its odontogenic epithelial differentiation. Histopathology. Dec 2004;45(6):573-9. [Medline].

  9. Hao J, Li TG, Qi X, et al. WNT/beta-catenin pathway up-regulates Stat3 and converges on LIF to prevent differentiation of mouse embryonic stem cells. Dev Biol. Feb 1 2006;290(1):81-91. [Medline].

  10. Darendeliler F, Karagiannis G, Wilton P, Ranke MB, Albertsson-Wikland K, Anthony Price D, et al. Recurrence of brain tumours in patients treated with growth hormone: analysis of KIGS (Pfizer International Growth Database). Acta Paediatr. Oct 2006;95(10):1284-90. [Medline].

  11. Karavitaki N, Warner JT, Marland A, Shine B, Ryan F, Arnold J, et al. GH replacement does not increase the risk of recurrence in patients with craniopharyngioma. Clin Endocrinol (Oxf). May 2006;64(5):556-60. [Medline].

  12. Smith ER, Manfredi M, Scott RM, Black PM, Moses MA. A recurrent craniopharyngioma illustrates the potential usefulness of urinary matrix metalloproteinases as noninvasive biomarkers: case report. Neurosurgery. Jun 2007;60(6):E1148-9; discussion E1149. [Medline].

  13. Bunin GR, Surawicz TS, Witman PA, et al. The descriptive epidemiology of craniopharyngioma. J Neurosurg. Oct 1998;89(4):547-51. [Medline].

  14. de Divitiis E, Cappabianca P, Cavallo LM, Esposito F, de Divitiis O, Messina A. Extended endoscopic transsphenoidal approach for extrasellar craniopharyngiomas. Neurosurgery. Nov 2007;61(5 Suppl 2):219-27; discussion 228. [Medline].

  15. Laufer I, Anand VK, Schwartz TH. Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. J Neurosurg. Mar 2007;106(3):400-6. [Medline].

  16. Fraioli MF, Moschettoni L, Catena E, Fraioli C. Cystic craniopharyngioma: trans-sphenoidal surgery and intra-cystic apposition of "bleomycin wax". Acta Neurochir (Wien). Apr 24 2009;[Medline].

  17. Lafay-Cousin L, Bartels U, Raybaud C, Kulkarni AV, Guger S, Huang A, et al. Neuroradiological findings of bleomycin leakage in cystic craniopharyngioma. Report of three cases. J Neurosurg. Oct 2007;107(4 Suppl):318-23. [Medline].

  18. Hukin J, Steinbok P, Lafay-Cousin L, Hendson G, Strother D, Mercier C, et al. Intracystic bleomycin therapy for craniopharyngioma in children: the Canadian experience. Cancer. May 15 2007;109(10):2124-31. [Medline].

  19. Takahashi H, Yamaguchi F, Teramoto A. Long-term outcome and reconsideration of intracystic chemotherapy with bleomycinfor craniopharyngioma in children. Childs Nerv Syst. Aug 2005;21(8-9):701-4. [Medline].

  20. Julow J, Lányi F, Hajda M, Szeifert GT, Viola A, Bálint K, et al. Stereotactic intracavitary irradiation of cystic craniopharyngiomas with yttrium-90 isotope. Prog Neurol Surg. 2007;20:289-96. [Medline].

  21. Derrey S, Blond S, Reyns N, Touzet G, Carpentier P, Gauthier H, et al. Management of cystic craniopharyngiomas with stereotactic endocavitary irradiation using colloidal 186Re: a retrospective study of 48 consecutive patients. Neurosurgery. Dec 2008;63(6):1045-52; discussion 1052-3. [Medline].

  22. Ierardi DF, Fernandes MJ, Silva IR, Thomazini-Gouveia J, Silva NS, Dastoli P, et al. Apoptosis in alpha interferon (IFN-alpha) intratumoral chemotherapy for cystic craniopharyngiomas. Childs Nerv Syst. Sep 2007;23(9):1041-6. [Medline].

  23. Savas A, Erdem A, Tun K, Kanpolat Y. Fatal toxic effect of bleomycin on brain tissue after intracystic chemotherapy for a craniopharyngioma: case report. Neurosurgery. Jan 2000;46(1):213-6; discussion 216-7. [Medline].

  24. Van den Berge JH, Blaauw G, Breeman WA, et al. Intracavitary brachytherapy of cystic craniopharyngiomas. J Neurosurg. Oct 1992;77(4):545-50. [Medline].

  25. Curtis J, Daneman D, Hoffman HJ, Ehrlich RM. The endocrine outcome after surgical removal of craniopharyngiomas. Pediatr Neurosurg. 1994;21 Suppl 1:24-7. [Medline].

  26. Bergman WC, Tse V, Schulz RA, et al. An improved stereotactic technique for cyst cannulation. Stud Health Technol Inform. 1999;62:45-8. [Medline].

  27. Hoffman HJ, De Silva M, Humphreys RP, et al. Aggressive surgical management of craniopharyngiomas in children. J Neurosurg. Jan 1992;76(1):47-52. [Medline].

  28. Izumoto S, Suzuki T, Kinoshita M, et al. Immunohistochemical detection of female sex hormone receptors in craniopharyngiomas: correlation with clinical and histologic features. Surg Neurol. Jun 2005;63(6):520-5; discussion 525. [Medline].

  29. Jakacki RI, Cohen BH, Jamison C, et al. Phase II evaluation of interferon-alpha-2a for progressive or recurrent craniopharyngiomas. J Neurosurg. Feb 2000;92(2):255-60. [Medline].

  30. Kobayashi T, Kida Y, Mori Y, Hasegawa T. Long-term results of gamma knife surgery for the treatment of craniopharyngioma in 98 consecutive cases. J Neurosurg. Dec 2005;103(6 Suppl):482-8. [Medline].

  31. Maiter D, Abs R, Johannsson G, Scanlon M, Jönsson PJ, Wilton P, et al. Baseline characteristics and response to GH replacement of hypopituitary patients previously irradiated for pituitary adenoma or craniopharyngioma: data from the Pfizer International Metabolic Database. Eur J Endocrinol. Aug 2006;155(2):253-60. [Medline].

  32. Meuric S, Brauner R, Trivin C, et al. Influence of tumor location on the presentation and evolution of craniopharyngiomas. J Neurosurg. Nov 2005;103(5 Suppl):421-6. [Medline].

  33. Nomura H, Kurimoto M, Nagai S, et al. Multiple intracranial seeding of craniopharyngioma after repeated surgery--case report. Neurol Med Chir (Tokyo). Jun 2002;42(6):268-71. [Medline].

  34. Novegno F, Di Rocco F, Colosimo Jr C, et al. Ectopic recurrences of craniopharyngioma. Childs Nerv Syst. Oct 2002;18(9-10):468-73. [Medline].

  35. Pereira AM, Schmid EM, Schutte PJ, et al. High prevalence of long-term cardiovascular, neurological and psychosocial morbidity after treatment for craniopharyngioma. Clin Endocrinol (Oxf). Feb 2005;62(2):197-204. [Medline].

  36. Pollock BE, Lunsford LD, Kondziolka D, et al. Phosphorus-32 intracavitary irradiation of cystic craniopharyngiomas: current technique and long-term results. Int J Radiat Oncol Biol Phys. Sep 30 1995;33(2):437-46. [Medline].

  37. Rajan B, Ashley S, Gorman C, et al. Craniopharyngioma--a long-term results following limited surgery and radiotherapy. Radiother Oncol. Jan 1993;26(1):1-10. [Medline].

  38. Regine WF, Kramer S. Pediatric craniopharyngiomas: long term results of combined treatment with surgery and radiation. Int J Radiat Oncol Biol Phys. 1992;24(4):611-7. [Medline].

  39. Sands SA, Milner JS, Goldberg J, et al. Quality of life and behavioral follow-up study of pediatric survivors of craniopharyngioma. J Neurosurg. Oct 2005;103(4 Suppl):302-11. [Medline].

  40. Sanford RA. Craniopharyngioma: results of survey of the American Society of Pediatric Neurosurgery. Pediatr Neurosurg. 1994;21 Suppl 1:39-43. [Medline].

  41. Sneed PK, Albright NW, Wara WM, et al. Fetal dose estimates for radiotherapy of brain tumors during pregnancy. Int J Radiat Oncol Biol Phys. Jun 15 1995;32(3):823-30. [Medline].

  42. Tarbell NJ, Barnes P, Scott RM, et al. Advances in radiation therapy for craniopharyngiomas. Pediatr Neurosurg. 1994;21 Suppl 1:101-7. [Medline].

  43. Ulfarsson E, Karstrom A, Yin S, et al. Expression and growth dependency of the insulin-like growth factor I receptor in craniopharyngioma cells: a novel therapeutic approach. Clin Cancer Res. Jul 1 2005;11(13):4674-80. [Medline].

  44. Voges J, Sturm V, Lehrke R, et al. Cystic craniopharyngioma: long-term results after intracavitary irradiation with stereotactically applied colloidal beta-emitting radioactive sources. Neurosurgery. Feb 1997;40(2):263-9; discussion 269-70. [Medline].

  45. Waber DP, Pomeroy SL, Chiverton AM, et al. Everyday cognitive function after craniopharyngioma in childhood. Pediatr Neurol. Jan 2006;34(1):13-9. [Medline].

  46. Weiner HL, Wisoff JH, Rosenberg ME, et al. Craniopharyngiomas: a clinicopathological analysis of factors predictive of recurrence and functional outcome. Neurosurgery. Dec 1994;35(6):1001-10; discussion 1010-1. [Medline].

  47. Yasargil MG, Curcic M, Kis M, et al. Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients. J Neurosurg. Jul 1990;73(1):3-11. [Medline].

  48. Yoshimoto M, de Toledo SR, da Silva NS, et al. Comparative genomic hybridization analysis of pediatric adamantinomatous craniopharyngiomas and a review of the literature. J Neurosurg. Aug 2004;101(1 Suppl):85-90. [Medline].

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Keywords

adamantinoma, craniopharyngeal duct tumor, Rathke pouch tumor, craniopharyngioma, cystic tumor, Rathke cleft, epithelial-squamous calcified cystic tumor

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Contributor Information and Disclosures

Author

George C Bobustuc, MD, Consulting Staff, Department of Neuro-Oncology, MD Anderson Cancer Center Orlando
George C Bobustuc, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, Society for Neuro-Oncology, and Texas Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Morris D Groves, MD, Assistant Professor, Department of Neuro-Oncology, MD Anderson Cancer Center, University of Texas
Morris D Groves, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Gregory N Fuller, MD, PhD, Professor of Pathology, Chief, Section of Neuropathology, Department of Pathology, Division of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center
Gregory N Fuller, MD, PhD is a member of the following medical societies: American Association of Neuropathologists, College of American Pathologists, International Academy of Pathology, Society for Neuro-Oncology, and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Franco DeMonte, MD, FRCSC, FACS, Professor of Neurosurgery, Mary Beth Pawelek Chair in Neurosurgery, The University of Texas, MD Anderson Cancer Center, Houston Texas
Franco DeMonte, MD, FRCSC, FACS is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Amy A Pruitt, MD, Associate Professor of Neurology, University of Pennsylvania; Attending Neurologist, Hospital of the University of Pennsylvania
Amy A Pruitt, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Jorge Kattah, MD, Head, Program Director, Professor, Department of Neurology, University of Illinois College of Medicine at Peoria
Jorge Kattah, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, and New York Academy of Sciences
Disclosure: Biogen Honoraria Consulting; Bayer Corporation Honoraria Consulting

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Tarakad S Ramachandran, MBBS, FRCP(C), FACP, Professor of Neurology, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Chair, Department of Neurology, Crouse Irving Memorial Hospital
Tarakad S Ramachandran, MBBS, FRCP(C), FACP is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners, American College of International Physicians, American College of Managed Care Medicine, American College of Physicians, American Heart Association, American Stroke Association, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, and Royal Society of Medicine
Disclosure: Abbott Labs  Honoraria Consulting; Teva Marion Honoraria Consulting; Boeringer-Ingelheim Honoraria Speaking and teaching

 
 
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