Craniopharyngioma: ophthalmological aspects at diagnosis

We studied ophthalmological signs at diagnosis in children with craniopharyngioma.

Twenty-nine children aged from 3 to 16 years (mean 9.1 years) were retrospectively studied. All of them had visual acuity measurement, oculomotor examination, fundoscopy and, whenever possible, visual field testing.

Visual signs were present at diagnosis in 96% of patients in our series, but were the circumstances of diagnosis of craniopharyngioma in only 34.5%. Loss of visual acuity was present at diagnosis in 15 patients (51.7%), strabismus in eight (27.6%), papilloedema in ten (34.4%), and optic nerve atrophy in 11 patients (37.9%). A visual field defect was present at diagnosis in all 18 children who were able to perform an instrumental visual field and in three of the children who were tested by attraction visual field.

In children, ophthalmological signs are not the main circumstance of diagnosis of craniopharyngioma because children do not complain of a mild or unilateral reduction in visual acuity. The central visual field is more often affected than the peripheral visual field; computerized static automated perimetry, which allows precise study of the central visual field, is difficult to perform in children. Because of the infiltrating nature of craniopharyngiomas, visual field defects are sometimes atypical and do not indicate a chiasmal problem.