Visual Outcome of Craniopharyngioma in Children

Abstract

PURPOSE: 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.