Extracranial Infrasellar Ectopic Craniopharyngioma: A Case Report and Review of the Literature

ABSTRACT

We present a case of a purely infrasellar craniopharyngioma that initially presented as a sphenoid sinus mass. Craniopharyngiomas are usually located within the sella. Purely infrasellar craniopharyngiomas have only rarely been reported in the literature. A 25-year-old woman presented with 6-month history of progressive headaches. Initial neuroimaging revealed the presence of a sphenoid sinus mass. Initially, she underwent an endoscopic biopsy of the mass by our ENT service. Pathology was consistent with craniopharyngioma and she was referred to neurosurgery for further surgical management. She then underwent an endoscopic transsphenoidal approach for complete resection of the purely extracranial, infrasellar craniopharyngioma. The Rathke pouch arises from the roof of the primitive mouth and grows toward the brain at the fourth week of gestation. Normally, it loses its attachment with the stomadeum completely by the eighth week of gestation. The craniopharyngeal canal (CPC) extends from the floor of the sella to the vomer and may rarely give rise to ectopic craniopharyngiomas. This case shows that such ectopic tumors may arise anywhere along the CPC. Endoscopic endonasal approach provides an excellent route for the resection of these tumors.

KEYWORDS

Craniopharyngioma - ectopic - Rathke pouch - infrasellar

REFERENCES

• 1 Lewin R, Ruffolo E, Saraceno C. Craniopharyngioma arising in the pharyngeal hypophysis.  South Med J. 1984;  77(12) 1519-1523
• 2 Illum P, Elbrond O, Nehen A M. Surgical treatment of nasophrayngeal craniopharyngioma. Radical removal by the transpalatal approach.  J Laryngol Otol. 1977;  91(3) 227-233
• 3 Hillman T H, Peyster R G, Hoover E D, Nair S, Finkelstein S D. Infrasellar craniopharyngioma: CT and MR studies.  J Comput Assist Tomogr. 1988;  12(4) 702-704
• 4 Long D M, Chou S N. Transcallosal removal of cranio-pharyngiomas within the third ventricle.  J Neurosurg. 1973;  39(5) 563-567
• 5 Altinörs N, Senveli E, Erdoğan A, Arda N, Pak I. Craniopharyngioma of the cerebellopontine angle. Case report.  J Neurosurg. 1984;  60(4) 842-844
• 6 Arndt S, Wiech T, Mader I, Maier W. Entire infrasellar craniopharyngioma simulating clival chordoma.  Otolaryngol Head Neck Surg. 2007;  137(6) 981-983
• 7 Benitez W I, Sartor K J, Angtuaco E J. Craniopharyngioma presenting as a nasopharyngeal mass: CT and MR findings.  J Comput Assist Tomogr. 1988;  12(6) 1068-1072
• 8 Byrne M N, Sessions D G. Nasopharyngeal craniopharyngioma. Case report and literature review.  Ann Otol Rhinol Laryngol. 1990;  99(8) 633-639
• 9 Petito C K, DeGirolami U, Earle K M. Craniopharyngiomas: a clinical and pathological review.  Cancer. 1976;  37(4) 1944-1952
• 10 Kitano I, Yoneda K, Yamakawa Y, Fukui M, Kinoshita K. Huge cystic craniopharyngioma with unusual extensions: a case report.  Neuroradiology. 1981;  22(1) 39-42
• 11 Nagasawa S, Handa H, Yamashita J, Kinuta Y. Dense cystic craniopharyngioma with unusual extensions.  Surg Neurol. 1983;  19(3) 299-301
• 12 Russel D S, Rubinstein L J. Pathology of Tumors of the Nervous System. 5th ed. Baltimore; Williams & Wilkins 1989: 695-702
• 13 Currarino G, Maravilla K R, Salyer K E. Transsphenoidal canal (large craniopharyngeal canal) and its pathologic implications.  AJNR Am J Neuroradiol. 1985;  6(1) 39-43
• 14 Arey L B. The craniopharyngeal canal reviewed and reinterpreted.  Anat Rec. 1950;  106(1) 1-16
• 15 Cohen R, Nelson Jr M D, Segall H D. Epignathic teratoma associated with craniopharyngeal canal.  AJNR Am J Neuroradiol. 1989;  10(3) 652
• 16 Weber F T, Donnelly Jr W H, Bejar R L. Hypopituitarism following extirpation of a pharyngeal pituitary.  Am J Dis Child. 1977;  131(5) 525-528
• 17 Drummond W A. Infrasellar adamantinoma: (Section of Laryngology).  Proc R Soc Med. 1939;  32(3) 200-207
• 18 Cooper P R, Ransohoff J. Craniopharyngioma originating in the sphenoid bone. Case report.  J Neurosurg. 1972;  36(1) 102-106
• 19 Prasad U, Kwi N K. Nasopharyngeal craniopharyngioma.  J Laryngol Otol. 1975;  89(4) 445-452
• 20 Podoshin L, Rolan L, Altman M M, Peyser E. ‘Pharyngeal’ craniopharyngioma.  J Laryngol Otol. 1970;  84(1) 93-99
• 21 Fitz C R, Wortzman G, Harwood-Nash D C, Holgate R C, Barry J F, Boldt D W. Computed tomography in craniopharyngiomas.  Radiology. 1978;  127(3) 687-691
• 22 Johnson L N, Hepler R S, Yee R D, Frazee J G, Simons K B. Magnetic resonance imaging of craniopharyngioma.  Am J Ophthalmol. 1986;  102(2) 242-244
• 23 Pusey E, Kortman K E, Flannigan B D, Tsuruda J, Bradley W G. MR of craniopharyngiomas: tumor delineation and characterization.  AJR Am J Roentgenol. 1987;  149(2) 383-388
• 24 Hald J K, Eldevik O P, Skalpe I O. Craniopharyngioma identification by CT and MR imaging at 1.5 T.  Acta Radiol. 1995;  36(2) 142-147
• 25 Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M. Surgical treatment of craniopharyngiomas: experience with 168 patients.  J Neurosurg. 1999;  90(2) 237-250
• 26 Ragoowansi A T, Piepgras D G. Postoperative ectopic craniopharyngioma. Case report.  J Neurosurg. 1991;  74(4) 653-655