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Visual outcomes after treatment of craniopharyngioma in children: A systematic review
Reid Colliander1, Shelly Sharma1, Nathan A Shlobin1
1Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Insights
Visual outcomes in children with craniopharyngiomas varied by treatment. Interferon-α and surgery alone showed the most visual improvement, while radiation alone led to the greatest deterioration.
Area of Science:
- Pediatric neuro-oncology
- Ophthalmology
- Clinical trial methodology
Background:
- Craniopharyngiomas (CP) are rare pediatric brain tumors often causing visual impairment due to optic pathway proximity.
- Optimal management to preserve visual function in pediatric CP patients remains controversial.
Conclusions:
- Intervention choice impacts visual outcomes in pediatric craniopharyngioma patients.
- Interferon-α and surgery alone appear most beneficial for visual improvement, whereas radiation alone poses the highest risk of deterioration.
- Standardized, large-scale randomized trials are needed to definitively assess treatment effects on ophthalmologic findings.
Objective:
Craniopharyngiomas (CP) are rare brain tumors that often result in visual impairment due to their proximity to the optic pathway. The optimal management approach to preserve visual function in these patients remains controversial. We sought to investigate visual outcomes of children with craniopharyngiomas based on treatment modality.
Methods:
A systematic review was performed according to PRISMA guidelines. PubMed, Embase, and Scopus databases were searched in December 2022 for relevant articles. Articles were screened by title/abstract for relevance, then by full-text. Relevant demographic, intervention, and outcome data were extracted from included studies.
Results:
A total of 59 studies were included, representing 2655 patients. The overall visual status (OVS) of patients receiving surgery alone was improved in 27.6% of reported outcomes, unchanged in 50.3%, and deteriorated in 22.1%. The OVS for patients receiving radiation alone was improved in 21.1%, unchanged in 42.1%, and deteriorated in 36.8%. Patients receiving surgery plus adjuvant radiotherapy had OVS improvement in 27.4%, unchanged in 63.2%, and deteriorated in 9.4%. Of those receiving intracystic bleomycin, 23.1% had improvement in OVS, 46.2% remained unchanged, and 30.8% deteriorated. Of patients receiving interferon-α, 34.8% improved, 54.5% remained unchanged, and 10.6% deteriorated.
Conclusion:
OVS most frequently remained unchanged regardless of intervention. The greatest improvement in OVS was seen in those receiving interferon-α or surgery alone. The greatest OVS deterioration was noted with radiation alone. Future standardized, randomized, large-scale studies with focused assessment of ophthalmologic findings are key to further understanding the impact different interventions have on visual outcomes in these children.
