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Neuro Radiology - Craniopharyngioma PowerPoint Presentation

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Description : Check out this medical presentation on Radiology and Imaging, which is titled "Neuro Radiology Craniopharyngioma", to know about Neuro Radiology.

Tags : Radiology, Imaging, Neuro Radiology, Craniopharyngioma

Published on : Jul 28, 2021 | Views : 1672 | Downloads : 3

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Neuro Radiology Craniopharyngioma Dr.Roopchand.PS Senior Resident Neurology
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Introduction: Benign (WHO grade I) neoplasms which typically arise in the sellar / suprasellar region. Account for ~ 1 - 5% of primary brain tumours. Can occur anywhere from floor of the third ventricle, to the pituitary gland. Two pathological types and they differ in appearance, epidemiology and prognosis. adamantinomatous (paediatric) papillary (adult) mixed: ~ 15%, but share imaging and prognosis similar to adamantinomatous
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Epidemiology: Bimodal distribution: First peak between the ages of 10 - 14 years Adamantinomatous type. Second peak in young to middle-aged adults Papillary type Similar incidence in males and females.
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Clinical presentation: Headaches and raised ICP Visual symptoms 20% of children 80% adults Hormonal imbalances short stature and delayed puberty in children decreased libido amenorrhoea diabetes insipidus Behavioural change due to frontal or temporal extension.
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Pathology: Arises from the Rathke’s cleft. This histological appearances of the two subtypes are different. Adamantinomatous: In children Reticular epithelial cells which have appearances reminiscent of the enamel pulp of developing teeth. single or multiple cysts filled with thick oily fluid high in protein, blood products, and/or cholesterol, creating the so called "machinery oil". "Wet keratin nodules" are a characteristic histological feature. Calcification is usually present : ~ 90%
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Papillary: Seen almost exclusively in adults Formed of masses of metaplastic squamous cells . "Wet keratin" is absent. Cysts do form, but these are less of a feature, and the tumour is more solid. Calcification is uncommon or even rare
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Radiographic features: Significant suprasellar component (95%), involving both the suprasellar and intrasellar spaces (75%). Purely suprasellar (20%), Purely intrasellar location is quite uncommon (<5%). Larger tumours can extend in all directions, frequently distorting the optic chiasm, or compressing the midbrain with resulting obstructive hydrocephalus. Occasionallycan appear as intraventricular, homogeneous, soft-tissue masses without calcification (papillary sub type). The third ventricle is a particularly common location. Rare / ectopic locations include: nasopharynx, posterior fossa, extension down the cervical spine.
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Adamantinomatous: Lobulated contour as a result of usually multiple cystic lesions. Solid components are present. o Form a relatively minor component of the mass, Enhance vividly on both CT and MRI. Calcification is very common, but this is only true of the adamantinomatous subtype (90% are calcified) Predilection to be large, extending superiorly into the third ventricle, and encasing vessels, and even being adherent to adjacent structures.
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CT cysts typically large and a dominant feature near CSF density solid component soft tissue density vivid enhancement calcification seen in 90% typically stippled and often peripheral in location
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MRI cysts: variable but ~80% are mostly or partly T2 hyperintense solid component T1: iso to lightly hypointense to brain T1 C+: vivid enhancement T2: variable / mixed calcification difficult to appreciate on conventional imaging susceptible sequences may better demonstrate calcification MR angiography: may demonstrate displacement of the A1 segment of the anterior cerebral artery MR spectroscopy: cyst contents may show a broad lipid spectrum, with an otherwise flat baseline 6
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T1 T1C
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Papillary : Papillary craniopharyngiomas tend to be more spherical in outline and usually lack the prominent cystic component. Most are either solid or contain a few smaller cysts. Calcification is uncommon or even rare in the papillary subtype
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CT cysts small and not a major feature near CSF density solid component soft tissue density vivid enhancement calcification uncommon - rare
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MRI: cysts when present they are variable in signal 85% T1 hypointense solid component T1: iso to lightly hypointense to brain T1 C+: vivid enhancement T2: variable / mixed MR spectroscopy: cyst contents does not show a broad lipid spectrum as they are filled with water fluid
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T1
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T1C
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T2
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Treatment is usually surgical with radiotherapy especially useful for incomplete resection. Benign local recurrence is seen in up to a third of patients. papillary has a much lower recurrence rate than adamantinomatous Differentials Rathke’s cleft cyst. Pituitary macroadenoma Intracranial terratoma.
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