- Cranyopharyngioma symptomatology
- Treatment of a cranyopharyngioma
The cranyopharyngioma is the benign tumor of a brain having an embryonal origin. It is most often localized in gipotalamo-pituitary area and arises from cells of an embryonal pharyngeal pocket of Ratke. Cranyopharyngiomas are characterized by existence of cystous and solid components, and in process of progressing of a tumor in it there can be cysts with yellowish-brown liquid, and also with high content of protein and cholesterol. Usually they meet at children's and teenage age, but also can be also at adults.
The cranyopharyngioma has an effect when it begins to squeeze structures of a brain or breaks circulation of liquor in a brain. Therefore most often they come to light already big sizes, usually more than 30 mm. For cranyopharyngiomas as benign tumors, slow growth, but is characteristic of them typically infiltrirovany in tissue of a hypophysis and its legs, in an optic nerve and a hiazma, and also intracranial arteries.
While these tumors do not prove in any way, they can remain undetected for many years. The symptomatology most often appears at the age of 10 - 20 years. In 55-60% of cases of a cranyopharyngioma are cystous educations, and only in 15% - solid. In other cases this tumor have the mixed structure. For a cranyopharyngioma haakterno so-called suprasellyarny situation, that is, over the Turkish saddle. In process of growth the tumor squeezes visual decussation, and also a hypothalamus with a hypophysis. As a result secretion of hormones of an adenohypophysis suffers, and in certain cases there can be also a so-called not diabetes mellitus.
The clinical picture of a cranyopharyngioma depends, first of all, on localization of a tumor and its sizes. If the tumor squeezes a hypophysis or its leg, there is a symptomatology of pituitary insufficiency that is shown by deficit of its hormones. Usually treat characteristic signs of a cranyopharyngioma a growth inhibition and sexual development, girls have a disturbance of a menstrual cycle, men have a decrease in a libido. Отмечатся also low-tallness and obesity. Hypersensitivity by cold, fatigue, locks and a xeroderma, hypotonia and a depression is characteristic. Vision disorders are possible. At a cranyopharyngioma intracranial pressure increases, mental development is broken, there is a hypopituitarism or partial hypofunction of an adenohypophysis. In certain cases there can be a giperprolaktinemiya (increase in prolactin hormone level blood) is shown by a galactorrhoea - allocations from a mammary gland. Besides, headaches and disturbances of consciousness are noted.
Diagnosis of a cranyopharyngioma, as well as other tumors of a brain, comes down to carrying out neurologic inspection and tool diagnostic methods. Besides, hormonal researches are conducted the Survey X-ray analysis of a skull helps to reveal often supra-or intrasellyarny kaltsinata, and a step an erosion of walls or increase in the sizes of the Turkish saddle in which there is a hypophysis.
The main role in diagnosis of tumors of a brain including cranyopharyngiomas, it is allocated for a computer tomography and a magnetic and resonant tomography. Both of these methods allow the doctor to receive the layer-by-layer image of tissues of brain therefore it is possible to estimate localization of a tumor, its form, the sizes and structure, and also the relation to the next fabrics. KT and MRT - noninvasive diagnostic methods, at this KT is based on x-ray emission, and in MRT the powerful electromagnetic field is used.
Treatment of a cranyopharyngioma:
The standard in treatment of a cranyopharyngioma is surgical intervention. Operation is performed on purpose completely to excise a tumor therefore pressure upon a hypophysis is eliminated and its function is recovered. Access to a hypophysis and a krinofaringioma at the same time depends on localization of the tumor. At a cranyopharyngioma arrangement preferential over a hypophysis pole (so-called suprasellyarny localization), a choice method the craniotomy - opening of a cranium usually is. In certain cases, when the tumor is characterized by rather small sizes (less than 3 cm) and an arrangement in a hypophysis (a so-called intrasellyarny arrangement) neurosurgeons resort to a so-called transsphenoidal endoscopic method. The minimum injury of transnazosfenoidalny approach does it by a choice method at surgical treatment of tumors with endo-and infrasellyarny growth. Transsphenoidal access is carried out through a nasal cavity. It allows to minimize risk of complications, to reduce injury of operation and to truncate the postoperative period.
The surgical method has also the shortcomings of a type of a certain risk of some complications. The risk of infection, bleeding or traumatizing soft tissues, and also nerves and vessels belong to these complications. In certain cases an operative measure at a cranyopharyngioma is possible, especially at hardly accessible localization of a tumor or serious condition of the patient, and also at associated diseases which can be contraindications to an operative measure. In this case neurosurgeons resort to radiation therapy. Earlier taditsionny radiation therapy at which radiation of area of the head by radiation bunch during the course consisting of several weeks was carried out was usually carried out. The course consisted of five sessions a week. A lack of traditional radiation therapy is the impossibility to completely destroy a tumor, but it allows to stop its growth and even to reduce its size.
Today traditional radiation therapy gives way to other its innovative and modern look - radio surgery which treat a gamma knife, a cyber-knife and новалис. The essence of radio surgery is that by means of the special device (or a helmet, in a case with a gamma knife) radiation of a tumor by posterior pyramids of radiation, every time from under different corners is carried out. As a result, through tissues of a brain there passes the weak harmless bunch of radiation, but, constantly meeting in the field of a tumor in it the maximum dose of radiation collects. The radio surgery is a noninvasive method of treatment, as well as radiation therapy, but effect its zasasty does not concede surgery. Difference from operation is only that the effect on a tumor arises not at once, and several weeks later.
From advantages of radio surgery it is possible to note, except its not invasiveness, lack of risk of complications which are inherent in operational treatment, lack of need for anesthesia, and lack of risk of complications of anesthesia, thus. High precision of the direction of a beam of radiation as during the session the provision of a tumor is controlled by means of KT or MPT is characteristic of radio surgery.
Besides, right after a radio surgery course the patient needs no recovery period, and it can go home. The method of radio surgery has no contraindications for the use. Treatment duration at radio surgery much less, than traditional radiation therapy. Well, and at last, It should be noted that the radio surgery can be an alternative to an operative measure and be applied when operation is impossible or the patient is inoperable.