Tumor features in adult papillary and adamantinomatous craniopharyngioma: neuroradiological evaluation of pituitary-hypothalamic-axis dysfunction and outcome prediction

Purpose: To identify radiological features distinguishing adamantinomatous craniopharyngioma (ACP) from papillary craniopharyngioma (PCP) and assess their impact on pituitary-hypothalamic-axis dysfunction and post-surgery recurrence. Methods: MRIs of 80 patients (48 with ACP, 32 with PCP) were analyzed for tumor topography, size, cystic-solid composition, peritumoral edema, signal intensity, and CT for calcification patterns. Volumes, normalized signal intensity minimum (nT2min) and maximum (nT1Max) values were measured from T2 and T1-weighted images, respectively. These variables were correlated with pituitary-hypothalamic-axis dysfunction and surgical outcomes. Results: There were no significant topographic differences between ACP and PCP (P > 0.85). ACP tumors had larger volumes (4992.2 ± 5195.5 mm³ vs. 814.4 ± 1023 mm³), a predominant cystic component, lower nT2min values (42.57% vs. 55.55%), higher nT1Max values (273.25% vs. 216.67%), and more peripheral calcifications (P < 0.001). In ACP lower nT2min and higher nT1Max values correlated with incomplete surgical excision (nT2min: P < 0.001, r = -0.607; nT1Max: P < 0.001, r = 0.817) while only lower nT2min values correlated with higher recurrence likelihood (nT2min: P < 0.001, r = -0.485). Regardless of histotype, tumors invading the third ventricle floor were more likely to show peritumoral edema (P < 0.001), hypothalamic infiltration (P < 0.001), and dysfunction (P = 0.013). Conclusion: Tumor location relative to the third ventricle and associated parenchymal changes are independent predictors of hypothalamic dysfunction, regardless of tumor histotype. ACP’s cystic composition characterized by a higher concentration of thick or proteinaceous material and peripheral calcifications predict poorer surgical outcomes.