Visual outcome after surgical removal of craniopharyngiomas

Thirty patients with craniopharyngiomas were examined preoperatively and immediately postoperatively to determine their level of visual impairment and the extent of visual recovery. Twenty-two patients also were examined during extended follow-up. Twelve of these patients were younger than 18 years of age and 18 were older than 18 years of age at the time of diagnosis. Visual acuity was reduced in 42% of eyes preoperatively. One week postoperatively, visual acuity was reduced in only 23% of eyes. Color vision was a more sensitive indicator of afferent system damage, being abnormal at presentation in 71% of patients. Visual field defects were typically bitemporal hemianopsias, but 20% of patients with evidence of optic neuropathy had no definite visual field deficit preoperatively. Postoperatively, 48% of patients had normal visual fields. There was no long-term improvement in visual acuity or field performance for patients with deficits present after the first postoperative month during an average 2.8 years of follow-up.