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Longitudinal Analysis of Visual Outcomes After Surgical Treatment of Adult Craniopharyngiomas

Kim, Young-Hoon MD*,‡; Kim, Chae-Yong MD, PhD*,‡; Kim, Jin Wook MD*,§; Kim, Yong Hwy MD*,§; Han, Jung Ho MD*,‡; Park, Chul-Kee MD, PhD*,§; Paek, Sun Ha MD, PhD*,§; Oh, Chang Wan MD, PhD*,‡; Kim, Dong Gyu MD, PhD*,§; Jung, Hee-Won MD, PhD*,§

doi: 10.1227/NEU.0b013e318262146b
Research-Human-Clinical Studies

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).

CONCLUSION: 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.

ABBREVIATIONS: CI, confidence interval

CRP, craniopharyngioma

GTR, gross total removal

STR, subtotal removal

VA, visual acuity

VD, visual deterioration

VF, visual field

VIS, visual impairment score

*Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea

Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Korea

§Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea

Correspondence: Hee-Won Jung, MD, PhD, Department of Neurosurgery, Seoul National University College of Medicine, 28 Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea. E-mail: hwnjung@snu.ac.kr

Received March 1, 2012

Accepted May 16, 2012

Copyright © by the Congress of Neurological Surgeons