Visual outcome of craniopharyngioma in children.
OBJECTIVE
To assess the visual outcome of children with craniopharyngioma and identify predictors of visual loss.


METHODS
A retrospective analysis of all patients younger than 18 at presentation who were evaluated between 1984 and 1995 was performed. Visual outcome was assessed as a function of age, systemic symptoms, visual acuity at presentation, and need for postoperative radiotherapy.


RESULTS
Thirty-one patients were identified, with a mean age of 7.7 years (range, 1.2 to 16.8 years) at the time of surgical resection. The initial visual acuity (known in 20 patients at presentation) in the better-seeing eye was > or = 20/40 in 14 (70%) patients and < 20/200 in 2 (10%) patients. Twelve (39%) patients presented with visual symptoms and 15 (48%) with systemic symptoms. All patients underwent surgical resection; some patients required multiple surgeries (52%) or adjuvant radiotherapy (48%). The mean postsurgical follow up was 6.5 years (range, 4 days to 25 years). Postoperative visual acuity was > or = 20/40 in the better eye in 22 (71%) patients; 8 (26%) patients had visual acuity < 20/200 in their better-seeing eye. Optic atrophy developed in 51 eyes of 27 patients (81%).


CONCLUSIONS
Craniopharyngioma presents with visual symptoms in children and is associated with significant permanent visual dysfunction. Age younger than 6 years at presentation and visual symptoms at presentation were associated with a significantly poorer visual outcome. Craniopharyngioma should be considered in the differential diagnosis of every child with amblyopia, particularly when no amblyogenic factors such as anisometropia or strabismus are present.
Abrams
L S
LS
Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, Md 21287-9009, USA.
Repka
M X
MX
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000503:physiopathology* / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010911:Pituitary Neoplasms / Q000503:physiopathology* / Q000532:radiotherapy / Q000601:surgery; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D014786:Vision Disorders / Q000503:physiopathology*; D014792:Visual Acuity / Q000502:physiology*