Patient With Craniopharyngioma

Patient With Craniopharyngioma

Length: 1240 words (3.5 double-spaced pages)

Rating: Excellent

Open Document

Essay Preview

More ↓
Discussion
A craniopharyngioma is a benign slow growing tumor most commonly occurring in the suprasellar region of the brain near the pituitary gland and optic nerves. The overall incidence of this tumor is about 1.2% and 4.6% with a peak incidence in children aged 5-14 years and in adults between 65 and 74 years of age (1, 2). The incidence does not vary by gender or race (2). These tumors account for 2% to 5% of all primary intracranial neoplasms (3).

Clinical Presentation. The most common presenting clinical features of craniopharyngiomas include headaches and visual field defects as well as nausea and vomiting (3, 4). Usually the visual disturbance manifests itself as a bitemporal hemianopsia as was the case with our patient. However, patients can also present with a homonymous hemianopia (5). The endocrine function may be suppressed and therefore manifest hypopituitarism, hypothyroidism, diabetes insipidus and or impotence (3, 4,5). Our presenting patient was positive for erectile dysfunction. On the other hand, there can also be an exaggeration of the endocrine system that may present as precocious puberty in children and obesity in adults (5).
Differential Diagnosis. The most common differential diagnosis considered when evaluating CT or MR images of craniopharyngiomas are (6):

Pituitary adenomas
Chiasmatic gliomas
Rathke’s pouch cyst
Epidermoid tumor

Pituitary adenomas tend to be bulkier and more likely to expand the sella, whereas craniopharyngiomas tend to expand upwardly leaving the bony sella unexpanded. The optic pathway gliomas differ from craniopharyngiomas in that they rarely involve the sella and are not usually calcified. Rathke’s cleft cysts can sometimes be challenging to differentiate from cranipharyngiomas, but these cysts are usually not solid or calcified. Epidermoid tumors rarely appear in the suprasellar area, but are still considered a possibility keeping in mind that enhancement of the peripheral rim is less common when compared to cranipharyngiomas (6).

Etiology. Craniopharyngiomas are not glial or neuronal lesions. They are epithelial neoplasms that can be both solid and cystic in nature (7). There are two theories as to how these tumors arise, the embryogenetic theory and metaplastic theory. The embryogenetic theory states that the Rathke’s pouch, which gives rise to the anterior pituitary gland during the fourth week of gestation, and the remnants of the craniopharygeal duct (the neck of the Rathke pouch) may be the site of origin for craniopharyngiomas. The metaplastic theory states residual squamous epithelial cells of the ectoderm of the embryo may undergo metaplasia and develop into a craniopharyngioma (5, 8).

How to Cite this Page

MLA Citation:
"Patient With Craniopharyngioma." 123HelpMe.com. 22 May 2019
    <https://www.123helpme.com/view.asp?id=458780>.

Need Writing Help?

Get feedback on grammar, clarity, concision and logic instantly.

Check your paper »

Essay about Craniopharyngioma

- Many children around the world seem healthy, but some may not always be so lucky. Many children have been diagnosed with craniopharyngioma, also known as a nonfunctioning pituitary macro adenoma. Some children in families may have a brain tumor, and in rare cases that child may have craniopharyngioma. Craniopharyngioma is said to be hereditary and comes from embryonic remnants, however no predisposed factors have been identified; therefore people must educate themselves on symptoms, treatments, and statistics....   [tags: Disease, Disorders]

Research Papers
1801 words (5.1 pages)

Essay on Neuropsychologist and Patient Perspectives

- Neuropsychologist and Patient Perspectives There are many classifications of tumors that compress or destroy the hypothalamus. A few forms are craniopharyngioma, germinoma, and glioma. Symptoms of craniopharyngioma include headaches, visual disturbances, pituitary hormone deficiencies, retardation of growth, and calcification of the sella region in children. Germinoma, also called ectopic pineoloma or atypical teratoma, has similar effects to serninoma of the testis or dysgerminoma of the ovary....   [tags: Tumors Cancer Neurology Medical Essays]

Free Essays
1563 words (4.5 pages)

Essay on Is It A Patient?

- Katz Index of Independence in Activities of Daily Living is utilized to assess whether or not a patient is able to live alone independently or needs assistance from others. This assessment tool allows the nurse to assign one point based on how many activities, such as “bathing, toileting, dressing, transferring, continence, and feeding,” the patient can do independently, (Tabloski, 2010, p. 14). R.H. was assessed using this assessment tool. He scored a six which indicates that he is fully independent....   [tags: Nursing, Nursing care plan, Patient, Assessment]

Research Papers
1464 words (4.2 pages)

Essay on Patient Scenario : A Nursing Patient

- Patient Scenario Daring my second semester I met a geriatric patient, The patient was a seventy-eight year old male. His medical diagnosis was dementia, anxiety, congestive heart failure, and benign prostatic hyperplasia (BPH). This gentleman’s BPH resulted in acute urinary retention which has symptoms of inability to urinate, painful urgent need to urinate, pain or discomfort in the lower abdomen, bloating of the lower abdomen. To access for BPH one asks the patient about difficulty in starting or continuing urination, reduced force or weak stream, sensation of incomplete bladder emptying, straining to begin urination, post void dribbling or leaking (Ignatavicius & Workman, 2013, p....   [tags: Health care provider, Health care, Patient]

Research Papers
1022 words (2.9 pages)

Patient Advocacy : An Advocate For Patients Essay

- Patient advocacy involves acting on behalf of patients who are unable to represent themselves, or those who do not wish to represent themselves (Kimble, 2012). When a nurse acts as an advocate for their patients they are able to empower the weak and vulnerable, releasing them from their discomfort and from unnecessary treatments (Kimble, 2012). During my clinical, there was one patient in particular who needed a patient advocate more than ever. The patient G. R., was quite ill at the time, he had no supports, no family or visitors, and was non-verbal....   [tags: Nursing, Nurse, Health care provider, Patient]

Research Papers
1745 words (5 pages)

Essay on The Treatment Of The Patient

- The patient is a 24 year old Caucasian female. She identifies as cisgender and as a heterosexual patient. She reports that she has never had any sexual trauma, nor has she ever been pregnant. This patient has been experiencing intense abdominal pain for more than ten years and has been seeing different medical specialists for most of that time. The patient has never received a diagnosis and states that she has often been told that the pain is either something she has invented for attention or that there is a sexual trauma she is not being honest about (Peabody, 2015)....   [tags: Patient, Physician, Hospital]

Research Papers
872 words (2.5 pages)

The Nurse Patient Relationship With My Patient Essay

- The nurse patient relationship begins to develop the moment a nurse steps into a patient’s room. Rapport is often overlooked in how it can affect the care and compliance of patients. During my experience on 5100 postpartum I have to learned how important it is to develop rapport with my patient right from the moment I meet them. Patients who do not feel a connection with their nurse are more likely not to trust them and follow their instructions or guidance (Barkley, 2015) In my particular experience with a patient I did not develop good rapport right from the beginning that resulted in her begin apprehensive to receiving an immunization....   [tags: Nursing, Patient, Nurse, Nursing skills]

Research Papers
729 words (2.1 pages)

Patient Centered Care And Patient Care Essay

- In the physical realm of patient-centered care pain, comfort, sleep, and rest are important aspects of the fourth dimension of patient-centered care. Patient-centered care is the complete focus of the medical team on providing respectful care to meet patient needs, preferences and values to guide decisions on each individual patient care. To understand the subjective view of the patient, these four aspects are at the forefront of their needs within the hospital setting to provide the best patient outcome....   [tags: Sleep, Sleep deprivation, Patient, Hospital]

Research Papers
967 words (2.8 pages)

A Physician And A Patient Essay

- Health professionals are constantly working on improvements because of ethical concerns that they face in their everyday lives. The relationship between a physician and a patient is often seen as a relationship with no errors or ethical concerns but that is not the case. There are constant adjustments that are made to ensure everyone is accounted for and treated in a humane manner. Although the health system focuses on accommodating for everyone, there are many times that adolescents suffer due to their inability to make their own decisions in a health setting....   [tags: Religion, Health care, Patient, Medicine]

Research Papers
1363 words (3.9 pages)

Patient With Dermatomyositis Essay

- Physical therapy is an evolving field and with the current push for direct access, physical therapists must have the skill set to recognize problems that fall outside their scope of care. Therefore, physical therapists must possess a background in recognizing the signs and symptoms of systemic infection and also be able to refer to the appropriate medical personnel. Dermatomyositis, is a condition that could be encountered by a physical therapist in a direct access situation, as it may mask as a musculoskeletal pathology in its early stages.1 Dermatomyositis CASE DISCRIPTION: Patient history and Systems Review A 30 year old Caucasian female was admitted on 10/17/2013 to an inpatient reha...   [tags: Patient Diagnosis]

Research Papers
970 words (2.8 pages)


There are three major clinical syndromes associated with the specific location of a craniopharyngioma. A craniopharyngioma located before the chiasm usually results in optic atrophy and visual field constriction. A retrochiasmal mass is associated with hydrocephalus and signs of increased intracranial pressure. In this case the patient will more than likely complain of headaches as well as double vision, and the fundus exam may reveal papilledema. An intrasellar craniopharyngioma presents with headaches and a hormonal imbalance (8). Though craniopharyngiomas are benign histologically, they are aggressive in behavior because they have a tendency to affect surrounding structures, which include the visual apparatus, hypothalamus, pituitary stalk, 3rd ventricle and vasculature from the circle of Willis (1).
Diagnosis. In order to properly diagnose a craniopharyngioma, the work-up should include a neuro-ophthalmic evaluation, a visual field exam, as well as imaging and endocrinologic studies. The modality of choice when imaging a craniopharyngioma is magnetic resonance (6). This usually shows a T1 high intensity area which is usually due to high protein content in the fluid of the cyst (6) In regards to endocrinologic studies, the labs should include serum electrolytes, thyroid studies, cortisol levels, growth hormone levels, luteinizing and follicle stimulating hormone levels (8).
Treatment. The man who first introduced the term ‘cranipharyngioma’ in 1932 described it as “one of the most baffling problems which confront the neurogurseon” (5, 9). The mainstay treatment is microsurgical resection. There are two approaches to the surgical procedure, transcranial or transphenoidal (figure 8). In a study of 168 patients undergoing surgery for the treatment of craniopharyngioma, the transcranial approach was the most frequently used (10). The transphenoidal approach had a lower mortality rate when compared with the transcranial route. Total tumor removal was accomplished 85.7% of the time during the transphenoidal procedure and only 45.7% using the transcranial route. The selection of the surgical approach is determined by the location of the tumor (7). The other modality in treating these tumors in addition to surgery is external beam radiotherapy (11). This approach is mainly reserved for patients who are not fit for surgery or in the case of residual or recurrent craniopharyngiomas (7, 9). In a review of 10 major studies which included a total of 264 patients in which gamma knife stereostatic radiosurgery was used to treat craniopharyngiomas, tumor control was accomplished in 75% of the cases (12).

Figure 8 a) transcranial b) transphenoidal surgical approach (13)
In addition to external beam radiotherapy, there is another minimally invasive approach called cyst aspiration. This method is reserved for patients with craniopharyngiomas that are predominantly cystic composed (1).
Recurrence. An analysis of 121 patients with craniopharyngiomas presenting to the Department of Pediatrics and Endocrinology between 1964 and 2003 showed there was a significant difference in the recurrence-free survival rate depending on the surgical treatment modality (4). The records of the patients were divided into 6 different groups (groups A-F). Group A consisted of 16 patients who underwent gross total tumor removal, group B included 3 patients who had gross total removal with follow-up radiotherapy, group C included 51 patients who underwent partial removal only, group D consisted of 33 partial removals with follow-up radiotherapy, group E included 6 cyst evacuations alone and finally group F consisted of 3 cyst evacuations with follow-up radiotherapy. The recurrence-free survival rate results at 10 years were as follows: 100% (A), 100% (B), 38% (C), 77% (D). Re-accumulation of the cyst happened in 58% of the patients in group F and in none of the patients in group E (4). There are other predictors of recurrence besides the extent of resection such as tumor size and whether the tumor has extended into the third ventricle as well as the presence of hydrocephalus and calcification (9). A majority of patients with recurrent cranipharyngiomas are symptomatic, and the two most common presenting symptoms are visual disturbances and headaches (9).
Prognosis. The five-year survival rate is 85% in children and 40% in adults (5). Many of these patients end up with hypothalamic dysfunction, an altered neuropsychological state, and visual field defects (5, 14). In addition, there is a high long-term cardiovascular morbidity (7). Patients who have a recurrence are more likely to have worse functional outcome and 29% more likely to have a permanent neurological deficit after repeat surgery (9). Repeat surgery is also associated with higher mortality and morbidity (9).
A study of 54 patients who underwent surgery for craniopharyngiomas at the Leiden University Medical Center showed a high prevalence of long-term cardiovascular, neurological and psychosocial morbidity (15). At a median follow-up period of 10 year (ranging from 36 months to 37 years), 7 patients had suffered from cerebrovascular accident, 1 patient had a transient ischemic attack and 3 patients experience a myocardial infarction. The cardiovascular morbidity was more common in premenopausal estrogen-deficient women. Neurological morbidity included short-term memory loss in 21 patients, personality changes in 16 patients, specific brain function impairment in 14 patients, anosmia in 8 patients and position dependent vertigo in 6 patients. Twenty-five patients showed psychosocial morbidity, which included inability to resume work, impaired school performance and visual deficits (15). Ten patients died, 40% from cardiovascular complications and 30% from infections, one patient died from cerebral hemorrhage. Most of these deaths occurred years after the initial operation (15).

Return to 123HelpMe.com