Acta Neurochir (Wien) (2001) 143: 1283±1285 Acta Neurochirurgica > Springer-Verlag 2001 Printed in Austria Case Reports Nasopharyngeal Extension of a Craniopharyngioma in a 4 Year Old Girl R. Buhl, A. Nabavi, M. Fritsch, and H. M. Mehdorn Department of Neurosurgery, University of Kiel, Germany Summary Nasopharyngeal extension of a craniopharyngioma is very rare and usually presents with headache, nasal obstruction and visual disturbances. We present a case of a 4 year old girl, who became symptomatic with visual deterioration. MRI showed a huge supra ± and infra- sellar cystic craniopharyngioma with extension into the sphenoid sinus. Primary treatment was a transnasal puncture of the cyst fol- lowed by a subfrontal approach with removal of the tumour pre- serving the chiasm and optic nerves. The visual acuity post- operatively improved while she needed hormone replacement due to panhypopituitarism. Follow-up 12 months after the operation showed no recurrence. This is the youngest patient of about 27 pa- tients reported so far in the literature. Keywords: Craniopharyngioma; nasopharyngeal extension; Mag- netic Resonance Imaging. Introduction Craniopharyngiomas account for about 10% of pe- diatric brain tumours. The extension is usually supra- sellar and they become symptomatic with impaired endocrine function and visual disturbances. Extension into the nasopharyngeal space is very rare. Only few case reports have been published. Ta- guchi et al. [12] found 27 cases of nasopharyngeal ex- tension of craniopharyngiomas in the literature. Four cases were recurrent craniopharyngiomas. Presenting symptoms are mainly visual distur- bances, nasal obstruction and worsening snore. Pre- operative MRI and CT are important to con®rm the exact extension and bony destructions or changes in the skull base. We add another case of a cranio- pharyngioma with extension into the nasopharynx in a 4 year old girl, who is one of the youngest patients with this type of tumour published so far. Case This 4 year old girl became symptomatic with deterioration of her visual acuity. This was observed by her parents over a period of 5 months. Ophthalmological examination showed atrophy of both optic nerves. Visual acuity was 0,2 on the right and 0,05 on the left side. Hormonal examination was within normal limits. MRI of her head revealed a huge cystic supra ± and infrasellar tumour with ex- tension into the sphenoid sinus. The chiasm was compressed. The size of the tumor was 6 cm in the cranio-caudally direction and about 3 cm within the sphenoid sinus. There was contrast enhance- ment after administration of Gd ± DTPA especially in the superior parts of the tumour. A craniopharyngioma seemed to be the most likely diagnosis. This tumour reached the superior orbital ®ssure on both sides. The ¯oor of the third ventricle was elevated. There was no hydrocephalus. The ®rst treatment in our department was a transnasal puncture of the cyst. Twenty ml of brownish ¯uid were removed. The CT post- operatively showed a decrease of the suprasellar cyst and the vision of the patient improved slightly. Two weeks later a MRI showed again a similar size of the cyst compared to the preoperative MRI. Fig. 1. CT Scan showing the bony erosion and destruction in the nasopharyngeal space