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So Dr. Shupack,

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we're here to summarize craniopharyngioma,

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which for you board takers,

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is the 2nd most common suprasellar mass in children.

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Peak incidents.

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Younger peak, 10 years of age.

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Second peak, 55 years of age.

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There's no gender predelection.

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They often, as this patient, present with visual changes

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with compression of the optic apparatus.

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The so-called mustache sign.

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They can have endocrine dysfunction.

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Look how the pituitary is getting squished.

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So, the pituitary is under duress.

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They may have decreased TSH secretion,

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decreased ACTH secretion.

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The patient is under further duress

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cause there's obstructive hydrocephalus

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as we discussed before.

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And then, if you do a fundoscopic examination,

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you're likely to see true papilledema.

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These are lesions that do like to calcify.

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There's two types,

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the adamantinomatous type,

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which is seen more frequently in kids.

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That one may calcify.

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It's often a big cystic mass, but very proteinaceous.

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Not like CSF, but I admit that there's a lot of variability

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in the T1 signal intensity of these lesions.

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The adamantinomatous variation, the one likely to calcify,

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in my experience, the adamantinomatous type,

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especially in kids or young adults,

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likely to go retroclival .

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Whereas the other type, the papillary variety,

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usually straight up on top,

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more solid, found in adults,

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and often, with some solid enhancement.

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These adamantinomatous types frequently do not enhance.

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And then, interestingly,

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even though this is a pretty high viscosity lesion,

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in some respects,

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a little bit like epidermoid,

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which diffusion restricts because of its strong viscosity.

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This lesion did not diffusion restrict.

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Here is the B-zero diffusion image,

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and then you start to raise the B value,

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and you would expect this to be brighter if it diffusion restricted.

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It didn't.

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And here's the ADC map on the right,

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further confirming that there's no diffusion restriction,

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and this adamantinomatous craniopharyngioma,

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separate and distinct from the pituitary gland.

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Let's move on. Shall we?