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Visual outcome of craniopharyngioma in children
1Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, Md 21287-9009, USA.
Insights
Craniopharyngioma in children often causes permanent vision loss, especially in those under six. Early diagnosis is crucial, as visual symptoms at presentation predict poorer outcomes.
Area of Science:
- Pediatric Ophthalmology
- Pediatric Neuro-oncology
- Ophthalmic Pathology
Background:
- Craniopharyngioma is a common pediatric brain tumor.
- These tumors can cause significant visual impairment due to their location near the optic pathways.
- Understanding visual outcomes and predictors of vision loss is critical for managing these patients.
Purpose of the Study:
- To evaluate the visual outcomes in children diagnosed with craniopharyngioma.
- To identify factors that predict visual loss in pediatric craniopharyngioma patients.
Main Methods:
- Retrospective analysis of pediatric patients (<18 years) evaluated between 1984 and 1995.
- Assessment of visual outcome based on age, symptoms, visual acuity, and radiotherapy.
- Data collected included initial and postoperative visual acuity, and development of optic atrophy.
Main Results:
- 31 pediatric patients were analyzed, with a mean age of 7.7 years at resection.
- 70% had visual acuity >= 20/40 initially; 10% had < 20/200.
- Postoperatively, 71% had visual acuity >= 20/40, but 26% had < 20/200. Optic atrophy occurred in 81% of eyes.
Conclusions:
- Craniopharyngioma frequently causes permanent visual dysfunction in children.
- Younger age (<6 years) and presenting visual symptoms are linked to worse visual outcomes.
- Consider craniopharyngioma in children with unexplained amblyopia, especially without strabismus or anisometropia.
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.