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KA Walton, TG Saunders; Visual Outcomes of Patients With Craniopharyngioma Managed in a Community-Based Practice Versus an Academic Medical Center . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2634.
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Purpose: Craniopharyngioma often compresses the optic chiasm causing optic nerve atrophy and decreased vision. Resection of the tumor may produce injury to the optic tract or inflammation and subsequent loss of vision. Although craniopharyngioma is the most common suprasellar mass of children and will likely be diagnosed by most pediatric ophthalmologists, little information is available regarding visual prognosis. In 1997, Drs. Abrams and Repka reviewed the outcomes of pediatric patients with craniopharyngioma followed at Johns Hopkins Hospital. The purpose of this study is to compare the visual outcomes of patients with craniopharyngioma managed in a community-based practice to those managed in an academic medical center. Methods: We performed a retrospective review of all patients evaluated by one pediatric and neuroophthalmologist in a private-practice setting from 4/92 to 1/00. Patient demographics, preoperative and postoperative visual acuity and optic nerve exam were compared to the same parameters from Drs. Abrams and Repkas' study. Clinical characteristics of each case including age, gender, surgical approach, MRI appearance, and use of radiation therapy were evaluated as risk factors for poor visual outcome. Results: Of seven patients, the average age at presentation was 8.6 years compared to the average age in the Abrams and Repka study of 7.7 years. Best-corrected visual acuity in the better-seeing eye at presentation was ≷/= 20/40 in 83% patients, compared to 70% in the other study. No patients saw worse than 20/200 in the better eye in this group, where as 26% did in the Abrams and Repka study. Mean surgical follow-up was 4.4 years and post operative visual acuity in the better seeing eye at longest follow-up was ≷/= 20/40 in 71% of patients, which is the same percentage found in the other study, and < 20/200 in 29%, compared to 26%. Optic atrophy was present in 79% of eyes in this group compared to 81% in the Abrams and Repka study. Conclusions: Craniopharyngioma can result in significant visual loss. Our results suggest that pediatric patients managed in a community-based practice present with grossly equivalent visual deficits and experience a similar clinical course compared to those cared for at an academic center. Both of these studies found greater visual deficits as a result of craniopharyngioma than the neurosurgical literature suggests. Further studies into the predictors of poor visual outcome would help guide post-operative ophthalmologic follow-up for these patients.
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