Longitudinal analysis of visual outcomes after surgical treatment of adult craniopharyngiomas.
BACKGROUND
Craniopharyngiomas (CRPs) often cause visual deterioration (VD) due to the close vicinity of the optic apparatus.


OBJECTIVE
To evaluate longitudinal visual outcomes after surgery of CRP and determine the prognostic factors thereof.


METHODS
One hundred forty-six adult patients who underwent surgery for newly diagnosed CRP were retrospectively reviewed. There were 87 male patients (60%), and the median age was 41 years (range, 18-75). The mean follow-up duration was 88.7 months (range, 24-307). A visual impairment score was used to assess the short-term (<1 month) and long-term (>2 years) visual outcomes.


RESULTS
Gross total removal was performed in 53 patients (36%), and tumor recurrence occurred in 40 patients (27%). The average preoperative, short- and long-term visual impairment scores were 44.4, 38.5, and 38.1, respectively, on a 0- to 100-point scale (with 100 indicating the worst vision). Short- and long-term VD occurred in 28 (19%) and 39 patients (27%), respectively. Subtotal removal (STR) alone (P = .010; OR = 4.8), short-term VD (P < .001; OR = 39.7), and tumor recurrence (P < .001; OR = 28.2) were significant risk factors for long-term VD in the multivariate analysis. Patients undergoing STR alone had higher tumor recurrence rates in comparison with those who underwent gross total removal or STR with adjuvant therapy (P < .001).


CONCLUSIONS
Short-term VD secondary to the surgical insult and the recurrence of the tumor were strong predictors of long-term visual outcomes after surgical treatment for CRP. STR alone may be an ineffective strategy for achieving tumor control and optimal visual outcomes in patients with CRP.
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
Young-Hoon
YH
Kim
Chae-Yong
CY
Kim
Jin Wook
JW
Kim
Yong Hwy
YH
Kim
Jung Ho
JH
Han
Chul-Kee
CK
Park
Sun Ha
SH
Paek
Chang Wan
CW
Oh
Dong Gyu
DG
Kim
Hee-Won
HW
Jung
D000293:Adolescent; D000328:Adult; D000368:Aged; D003397:Craniopharyngioma / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000150:complications* / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014786:Vision Disorders / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult