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Six autopsy cases of craniopharyngioma were examined macro and microscopically. The causes of death were as follows: four cases died of recurrence, one of postoperative bleeding and one of sudden herniation due to the tumor. In four cases the tumors were located behind the chiasm with large cyst expanding in the postero-superior direction. In the remaining two cases solid tumors filled a large cyst in the third ventricle. Internal hydrocephalus was seen in all cases. The large cystic walls were composed of two layers. The inner layer was tumor tissue and the outer layer was gliosis. The mean widths of the tumor layer and gliosis were 0.2 mm and 0.5 mm, respectively. The mean distance between tumor layer and adjacent hypothalamic nuclei was 2 mm. Usually the tumor wall and gliosis firmly adhered to the adjacent brain tissues. Only in the case of one child, the connection between the cyst wall and brain tissue appeared to be very loose. There were thin layers of hypervascularization in the surrounding brain tissue. These vessels were 20 to 500 microns in diameter. The results indicate that a complete removal of the tumor, particularly the large cystic wall, produces severe damage to the surrounding brain structures. For the treatment of the large cyst, intermittent aspiration of the cystic fluid and intracystic irradiation and chemotherapy (using Bleomycin) are useful.

Operative Procedures of Craniopharyngioma Estimated by Autopsy Findings