Abstract
Purpose:
To evaluate visual outcomes in a large cohort of pediatric patients treated for craniopharyngioma.
Methods:
Retrospective chart review of all patients seen in the department of ophthalmology at a large tertiary care children's hospital over a 26 year study period with the diagnosis of craniopharyngioma (ICD-9 237.0). Complete ophthalmic data, neurosurgical treatment, and neuro-oncologic management were recorded.
Results:
Thirty-two patients were identified of which 50% were female. Mean age at diagnosis was 6.3 years (range from 1 to 15 years). The most common presenting symptoms included endocrinologic abnormalities (23/32 patients, 72%), headache (22/32 patients, 69%), and blurry vision (20/32 patients, 63%). As an initial treatment, total tumor resection occurred in 20/32 patients (62.5%), subtotal resection in 5/32 patients (15.6%), and subtotal resection plus radiation in 7/32 patients (21.9%). Preoperative ophthalmic data was available in 11/32 patients (34%). Of these, 3/32 had vision worse than 20/200 in the better seeing eye and 14/32 had visual field defects. Postoperatively, in best seeing eyes: 25 eyes had vision 20/40 or better, 2 eyes 20/40-20/200, 5 eyes 20/200 or worse; in worst seeing eyes, 14 eyes had vision 20/40 or better, 6 eyes 20/40-20/200, 12 eyes 20/200 or worse. Visual field defects were present in 28/32 patients. Optic atrophy was noted in 20/32 patients (63%).
Conclusions:
There is a high degree of visual morbidity associated with pediatric craniopharyngioma. In spite of aggressive treatment, visual outcomes may be poor. Contrary to previous reports, however, some patients in this group experienced improvement in vision post-operatively.
Keywords: 744 tumors •
760 visual search •
759 visual impairment: neuro-ophthalmological disease