Giant cystic craniopharyngiomas with extension into the posterior fossa

Between 1991 and 1998, 24 patients underwent surgery for a craniopharyngiom a in our department. This group included two patients who had tumors with e xtensive growth along the midline, and along the posterior fossa in particu lar. In both cases suprasellar calcifications were typical features on magn etic resonance imaging (MRI) and computed tomography (CT). A 7-year-old boy presented with a 6-month history of headache, nausea, and progressive unil ateral hearing loss. With a suboccipital approach it was possible to remove the main part of the tumor. In a 13-year-old buy headache and visual deter ioration led to the diagnosis of a craniopharyngioma, which was removed wit h a pterional approach. For the neuroimaging work-up in such cases of atypi cally growing craniopharyngiomas MRI is the method of choice. Additional CT scanning is recommended, which provides valuable information about bony ch anges at the skull base due to space-occupying growth. CT substantiates the differential diagnosis if typical calcifications are seen.