Craniopharyngiomas are derived from remnants of the craniopharyngeal duct (narrowing which separates Rathke’s pouch from the primitive oral cavity), and can occur anywhere along the infundibulum (from floor of the third ventricle, to the pituitary gland).

There is a bimodal distribution, with the first peak between the ages of 10 – 14 years and the second peak in the 7th decade.

There are two main types of craniopharyngiomas:

* adamantinomatous (paediatric)
* papillary (adult)

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Imaging findings depend on the histological subtype and on the size and content of the cysts.

T1 signal intensity varies depending on cyst contents, and can appear hyperintense due to protein, blood products, and/or cholesterol (in the classic adamantinomatous type). In the papillary variety, solid components appear isointense on T1-weighted images.

Contrast enhancement is typical, with either thin enhancement of the cyst wall, or diffuse heterogeneous enhancement of the solid components.

T2 signal is high in both solid and cystic components, but is variable depending on content of fluid. On T2* weighted sequences calcification may be seen as areas of signal drop out and blooming.

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1. Atlas SW, ed: Magnetic Resonance Imaging of the Brain and Spine. 2nd ed. Lippincott-Raven; 1995: 894-8.
2. SN Saleem et al “Lesions of the Hypothalamus: MR Imaging Diagnostic Features” RadioGraphics 2007;27:1087-1108
3. – craniopharyngioma

Credit: Dr Frank Gaillard