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Postoperative Visual Outcomes in Pediatric Craniopharyngioma: A Comparison of Endoscopic Endonasal and Transcranial
Olivia A Do1, Laura C Huang2, Lydia T Tam1
1Department of Pediatrics.
Insights
Pediatric craniopharyngioma surgery via endoscopic endonasal or transcranial approaches yielded similar visual outcomes. Endoscopic resection achieved higher rates of gross total tumor removal, preserving vision in selected patients.
Area of Science:
- Pediatric Neurosurgery
- Ophthalmology
- Surgical Oncology
Background:
- Craniopharyngioma is a rare brain tumor affecting children.
- Surgical resection is the primary treatment modality.
- Visual outcomes are a critical measure of surgical success.
Purpose of the Study:
- To compare postoperative visual outcomes in pediatric craniopharyngioma patients.
- Evaluate visual acuity, optic nerve status, and visual fields.
- Assess outcomes based on endoscopic endonasal versus transcranial craniotomy approaches.
Main Methods:
- Retrospective review of 37 pediatric patients (1995-2023).
- Ophthalmologic evaluations including visual acuity, optic nerve findings, and visual fields.
- Comparison of outcomes at early, intermediate, and long-term follow-up by surgical approach.
Main Results:
- No significant differences in visual acuity or visual fields between endoscopic and craniotomy groups.
- Optic nerve pallor was slightly more frequent in the endoscopic group (not significant).
- Gross total resection rates were higher with the endoscopic approach (66%) compared to craniotomy (34%).
Conclusions:
- Both surgical approaches offer comparable visual outcomes for pediatric craniopharyngioma.
- The endoscopic approach demonstrated higher rates of gross total resection.
- Surgical technique selection should be anatomy-driven to preserve visual function.
Objective:
To compare postoperative visual outcomes in pediatric patients undergoing resection of craniopharyngioma via endoscopic endonasal versus transcranial craniotomy approaches.
Methods:
We retrospectively reviewed 37 pediatric patients (74 eyes) who underwent resection of histologically confirmed craniopharyngioma at a tertiary center between 1995 and 2023. Ophthalmologic evaluations included best-corrected visual acuity (VA), optic nerve findings, and visual fields. Outcomes were assessed at early, intermediate, and long-term follow-up and compared by surgical approach.
Results:
Twenty-five patients (68%) underwent craniotomy and 12 (32%) endoscopic resection. Preoperatively, 51% had normal vision in both eyes, while 6 were legally blind. Postoperatively, no significant differences in VA or visual fields were observed between approaches at any interval. Optic nerve pallor was somewhat more frequent in the endoscopic group, though not statistically significant. Gross total resection was achieved in 66% of endoscopic versus 34% of craniotomy cases. Most craniotomies (88%) occurred before 2015, compared with 16% of endoscopic cases.
Conclusions:
Both endoscopic and transcranial approaches yielded comparable visual outcomes in pediatric craniopharyngioma surgery. Rates of gross total resection were higher in the endoscopic cohort, suggesting that surgical approach should remain anatomy-driven, with either technique capable of preserving visual function in appropriately selected patients.
