Craniopharyngioma in the Elderly

Although craniopharyngiomas comprise only a small proportion of intracranial tumours, by virtue of a unique situation close to what Cushing called the mainspring of primitive existence, they have an interest and importance out of proportion to their numbers. Since the tumours are congenital it is not surprising that the majority should present early in life, and many descriptions have been given to the effects produced in children and young adults. It used to be thought that the finding of a craniopharyngioma in an older patient was a rarity, but it now appears that an appreciable proportion of patients have their first symptoms after the age of 40, and that important differences exist between these and younger patients. In chil-dren there are two main syndromes: first, visual failure from compression of the optic nerve and chiasm, and secondly, symptoms and signs of in-creased intracranial pressure such as headache, papilloedema, and separation of the cranial sutures without specific visual field defects. This latter group results from obstruction of the third ventricle by the tumour. Evidence of hypothalamic and pituitary damage, as shown by various forms of endocrine or growth abnormality, is common, and radiological calcification is often seen. In adults there is much less tendency for the tumour to obstruct the flow of cerebrospinal fluid and the incidence of endocrine abnormality also falls sharply. Visual failure from chiasmal compression remains common, and mental disturbance, a rare feature in young patients, becomes of increasing importance. It is with these two features that this report is chiefly concerned.