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Cranial Cavity

The skull.

The crainial cavity is the boney structure that contains the brain; the largest portion of the central nervous system.

Craniectomy

Surgery performed on the skull where pieces of bone are removed to gain access to the brain, and the bone pieces are not replaced.

See craniotomy.

Craniopharyngioma

Craniopharyngiomas are intracranial tumors that are typically both cystic and solid in structure. They occur most commonly in childhood and adolescence and in later adult life after age 50 years. They account for 2-4% of primary brain tumors.

Craniopharyngiomas are usually not discovered until they press on important structures around them, and are frequently quite large (over 3 cm) when detected. They are histologically benign (not malignant) tumors, but they have a tendency to become adherent to structures in and around the pituitary gland and pituitary stalk, including the optic nerves, optic chiasm, intracranial arteries and the brain itself. They are thought to arise from remnants of the craniopharyngeal duct or Rathkes pouch which are developmental structures related to the primitive gut. Embryonic cells from an incompletely involuted craniopharyngeal duct or anterior pituitary gland may give rise to a craniopharyngioma. These tumors are closely related to another cystic masses occasionally seen in the pituitary called Rathkes cleft cyst.

Symptoms

The symptoms produced by a craniopharyngioma vary depending upon the tumors location. If it compresses the pituitary stalk or involves the area of the pituitary gland itself, the tumor can cause partial or complete pituitary hormone deficiency. This frequently results in one or more of the following: growth failure, delayed puberty, loss of normal menstrual function or sexual desire, increased sensitivity to cold, fatigue, constipation, dry skin, nausea, low blood pressure, and depression.

Pituitary stalk compression can also cause diabetes insipidus and may increase prolactin levels causing a milky discharge from the breast (galactorrhea). If the craniopharyngioma involves the optic tracts, chiasm, or nerves, then visual disturbances can result. Involvement of the hypothalamus, an area at the base of the brain, may result in obesity, increased drowsiness, temperature regulation abnormalities, and diabetes insipidus (DI). Other common symptoms include personality changes, headache, confusion, and vomiting.

Diagnosis

The best means of visualizing a craniopharyngioma is with a MRI or CT scan of the pituitary region performed without and with contrast.

Treatment

The initial treatment for a craniopharyngioma is usually surgery. The goal of surgery is to completely remove the tumor while improving or at least preserving pituitary, visual and brain function. Depending upon the location of the tumor, several approaches may be utilized. If the tumor is predominantly above the pituitary fossa (suprasellar), a craniotomy is generally required for optimal exposure and tumor removal. In a minority of patients, the tumor is relatively small (less than 3 cm) and located primarily in the area of the pituitary gland (intrasellar). In such patients, a transsphenoidal route can be used. When the tumor cannot be completely removed, radiation treatment generally offers some degree of tumor control and prolonged survival. Both conventional (external beam) and stereotactic radiosurgery are effective in controlling growth of craniopharyngiomas, but stereotactic radiation delivers a higher radiation dose to the tumor more safely. Consequently it is the preferred radiation technique. Because hormone deficiencies can develop due to the tumor mass effect or many years after radiation treatment, all individuals treated with radiation should have periodic evaluations by an endocrinologist throughout their lifetimes. Additionally, because of the tendency for craniopharyngiomas to recur, repeat MRIs or CT scans should be obtained at least once a year for the first several years after surgery or radiation therapy.

Craniotomy

Surgery performed on the skull where a portion of bone is removed to gain access to the brain, and the bone is put back in its place.

An operation in which an opening is made in the skull to reach areas of the brain and the structures around it. An incision is made through the scalp and a hole is drilled through the skull, or a piece of the skull may be removed to access and treat portions of the brain.

CRH

Corticotropin releasing hormone.

Produced by the hypothalamus and stimulates ACTH release by the pituitary gland.

Crohn's Disease (Also Known As Regional Enteritis

A moderately severe chronic inflammation of the intestine, especially of the small intestine, of unknown cause, involving the obstruction of the lower part of the small bowel and less frequently other parts of the gastrointestinal tract. It is characterized by patchy deep ulcers that may cause abnormal passages within the bowel, and narrowing and thickening of the bowel. Symptoms include fever, diarrhea, cramping abdominal pain, and weight loss.

Crohn's disease usually involves the small intestine, most often the lower part (the ileum). In some cases, both the small and large intestine (colon or bowel) are affected. In other cases, only the colon is involved. Sometimes, inflammation also may affect the mouth, esophagus, stomach, duodenum, appendix, or anus. Crohn's disease is a chronic condition and may recur at various times over a lifetime.

CSF

Cerebrospinal fluid.

See Cerebrospinal fluid.

CT or CAT Scan (Computerized Axial Tomography)

An x-ray device linked to a computer that produces an image of a predetermined cross-section of the brain. A special dye material may be injected into the patient's vein prior to the scan to help make any abnormal tissue more evident.

Computed tomography, also known as a CT scan, is a noninvasive, painless process used to produce rapid, clear two-dimensional images of organs, bones, and tissues. Neurological CT scans are used to view the brain and spine. They can detect bone and vascular irregularities, certain brain tumors and cysts, herniated discs, epilepsy, encephalitis, spinal stenosis (narrowing of the spinal canal), a blood clot or intracranial bleeding in patients with stroke, brain damage from head injury, and other disorders. Many neurological disorders share certain characteristics and a CT scan can aid in proper diagnosis by differentiating the area of the brain affected by the disorder.

Cysts

Abnormal sacs containing gas, fluid, or a semisolid material, with a membranous lining.

A closed sac having a distinct membrane and developing abnormally in a body cavity or structure. Arachnoid cysts are cerebrospinal fluid-filled sacs that are located between the brain or spinal cord and the arachnoid membrane, one of the three membranes that cover the brain and spinal cord. Primary arachnoid cysts are present at birth and are the result of developmental abnormalities in the brain and spinal cord that arise during the early weeks of gestation. Secondary arachnoid cysts are not as common as primary cysts and develop as a result of head injury, meningitis, or tumors, or as a complication of brain surgery.

Cytotoxic

Relating to or producing a toxic effect on cells. Capable of killing cells.

Cytotoxic chemotherapy is the anticancer drugs that kill cells, especially cancer cells. Cytotoxic T cell is a type of white blood cell that can directly destroy specific cells. T cells can be separated from other blood cells, grown in the laboratory, and then given to a patient to destroy tumor cells. Certain cytokines can also be given to a patient to help form cytotoxic T cells in the patient's body.

Debulk

A surgical procedure to decrease mass effect by removing a portion of a tumor or dead tissue. See mass effect.

Surgical removal of as much of a tumor as possible. Debulking may increase the chance that chemotherapy or radiation therapy will kill all the tumor cells. It may also be done to relieve symptoms or help the patient live longer. Also called tumor debulking.

Decadron

Dexamethasone. A glucocorticosteroid medication used to reduce brain tissue swelling.

Also used, in low doses, to treat adrenal insufficiency.

Decompressive

Refers to a surgical procedure during which bone, tissue, or tumor is removed to lessen intracranial pressure.

Decompressive craniectomy is an advanced treatment option for intracranial pressure (ICP) control in patients with traumatic brain injury.

Dedifferentiate

A mature cell returning to a less mature state. See differentiate, undifferentiated.

In cancer, refers to how mature (developed) the cancer cells are in a tumor. Differentiated tumor cells resemble normal cells and tend to grow and spread at a slower rate than undifferentiated or poorly differentiated tumor cells, which lack the structure and function of normal cells and grow uncontrollably.

Delivery

See drug delivery.

See drug delivery.

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