Adamantinomatous craniopharyngioma

Case contributed by Erik Ranschaert
Diagnosis probable


Headaches for 4 weeks mainly in the evenings and during the night, no visual disturbances.

Patient Data

Age: 11 years
Gender: Female

MRI pituitary region


A suprasellar nodular mass with cystic components. The solid component is located above the pituitary gland. The post-contrast acquisition demonstrates enhancement of the solid nodule and walls of the cystic component.

Evidence of obstructive hydrocephalus of the lateral ventricle with transependymal edema.

Case Discussion

Adamantinomatous craniopharyngiomas​ typically involve the sella and suprasellar space. Some craniopharyingiomas can be both intrasellar and suprasellar, having a "snowman" appearance.

Description of MRI findings:

  • cystic area which is hyperintense on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images with heterogeneous isointense to hypointense solid components in the caudal part. 
  • signal intensity varies on T1-weighted images. The cystic contents can appear hyperintense if they have a high protein, blood product, and/or cholesterol content. In this case the cystic component is T1-isointense.
  • contrast enhancement is seen, which is characteristic. 
  • compression of the third ventricle may occur and hydrocephalus may be present. Such compression helps in distinguishing craniopharyngioma from Rathke's cleft cyst or pituitary adenoma.

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