Welcome to CNS Case of the Month Section. The purpose of this Web area is to provide a forum for discussion and debate regarding the management of both ordinary and extraordinary cases. There are no right or wrong answers, but rather, there are various opinions on what should be the "standard of care." The answers given will be collected anonymously, and be presented in a graphical format at the end of each month. We will then see the spectrum of thought regarding the management of these patients.
We are always open to suggestions, and if you have a case or questions that you would like to have presented, please submit them to: info@1cns.org
Brian L. Hoh, MD University of Florida
Ashok R. Asthagiri, MD National Institutes of Health
Prashant Chittiboina, MD LSU Health Sciences Center
Sunil Manjila, MD University Hospitals Case Medical Center, CWRU School of Medicine, Cleveland
Maryam Rahman, MD University of Florida
Cara Sedney, MD West Virginia University, Robert C. Byrd Health Sciences Center
May 2013: Suprasellar Mass in a Child
H&P
11 yo M presented with headaches
No PMH, PSH, or meds
Normal function in school
Neurologically intact
Figure 1:
Figure 2:
a. Pituitary adenoma
b. Teratoma
c. Craniopharyngioma
d. Pilocytic astrocytoma
e. Rathke’s cleft cyst
2. What would the best initial workup include?
a. CTA
b. Ophthalmology evaluation
c. Endocrine workup
d. Lumbar puncture
e. B&C
f. C&D
g. All of the above
3. What initial treatment would you offer this patient?
a. Serial imaging
b. Pterional craniotomy for resection
c. Endoscopic transcortical resection through the third ventricle
d. Stereotactic needle biopsy
e. Radiation
4. What potential adverse outcomes would NOT be expected?
a. Obesity
b. Diabetes insipidus
c. Hydrocephalus
d. Short stature
e. Visual disturbance
f. Carotid stenosis
5. Which of the following describes you?
a. Resident/fellow
b. Private practice
c. Academics
6. I practice in one of the following locations.
a. I practice in one of the following states: WA, OR, CA, AK, HI
b. I practice in one of the following states: AZ, ID, NV, MT, WY, CO, NM, UT
c. I practice in one of the following states: ND, SD, NE, KS, OK, MN, IA, MO, WI, IL MI, IN, OH
d. I practice in one of the following states: TX, AR, AL, LA, KY, TN, MS, WV, NC, SC, GA, FL
e. I practice in one of the following states: ME, VT, NH, MA, RI, CT, NJ, NY, PA, DE, MD, DC, VA
f. I practice in Mexico or Canada
g. I practice in South America
h. I practice in Europe
i. I practice in Asia
j. I practice in Australia/Pacific Rim
k. I practice in Africa
7. Comments
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Muller HL. Childhood craniopharyngioma-current concepts in diagnosis, therapy and follow-up. Nat Rev Endocrinol. Nov;6(11):609-18,2010.
Clark AJ et al. Treatment related morbidity and the management of pediatric craniopharyngioma: a systematic review. J Neurosurg Pediatr. Oct;10(4):293-301,2012.
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