Craniopharyngiomas are rare and benign tumors of the sellar and/or parasellar region. Primary treatment involves resection followed by adjuvant radiotherapy. While the grade of resection was frequently analyzed following surgery, the neurological outcome and especially neuropsychological deficits and quality of life have been neglected for many decades. Therefore, the authors retrospectively analyzed their patient series and prospectively assessed neuropsychological outcome and quality of life following resection of craniopharyngiomas in adults.
In total, 71 patients (39 men and 32 women) with a mean age of 49 years were enrolled in the retrospective analysis. In addition, 36 of the 71 patients were included in the prospective arm of the study and underwent neurological and neuropsychological testing as well as quality of life (36-Item Short-Form Health Survey; SF-36) assessment. Factors influencing outcome were identified and correlations calculated.
Resection was performed mostly using a pterional (41.6%, 47/113 surgical procedures) or bifrontal translamina terminalis (30.1%, 34/113 surgical procedures) approach. Following surgery, visual acuity was significantly improved (> 0.2 diopters) in 32.4% (23/71) of patients, or remained stable in 45.1% (32/71) of patients. During long-term follow up, 80.3% (57/71) of patients developed pituitary insufficiency, particularly involving the corticotropic and thyrotrophic axes. In total, 75% (27/36) of patients showed neuropsychological deviations in at least 1 test item. In particular, attentiveness, cognitive speed, and short-term memory were affected. Referring to the SF-36 score, quality of life was affected in both the mental and physical score in 19.4% (7/36) and 33.3% (12/36), respectively. The risk factors that were identified were a tumor volume larger than 9 cm3, tumor extension toward/into the third ventricle or the brainstem, and resection using a bifrontal translamina terminalis or left-sided approach.
This study demonstrated that resection of craniopharyngiomas is frequently associated with postoperative neuropsychological deficits and hence an impaired quality of life. In addition to tumor size and extension toward/into the third ventricle or the brainstem, selection of the surgical approach may play a crucial role in the patient’s neuropsychological outcome and quality of life.
ABBREVIATIONSEEA = endoscopic endonasal approach; GTR = gross-total resection; ROCF = Rey–Osterrieth Complex Figure Test; SF-36 = 36-Item Short-Form Health Survey; STR = subtotal resection; TAP = Test-Battery for Attention; TMT = Trail Making Test; VLMT = Verbal Learning and Memory Test.
FjalldalSHolmerHRylanderLElfvingMEkmanBÖsterbergK: Hypothalamic involvement predicts cognitive performance and psychosocial health in long-term survivors of childhood craniopharyngioma. J Clin Endocrinol Metab98:3253–32622013
KaufmannLZierenNZotterSKarallDScholl-BürgiSHaberlandtE: Predictive validity of attentional functions in differentiating children with and without ADHD: a componential analysis. Dev Med Child Neurol52:371–3782010
PereiraAMSchmidEMSchuttePJVoormolenJHCBiermaszNRvan ThielSW: High prevalence of long-term cardiovascular, neurological and psychosocial morbidity after treatment for craniopharyngioma. Clin Endocrinol (Oxf)62:197–2042005
Sánchez-CubilloIPeriáñezJAAdrover-RoigDRodríguez-SánchezJMRíos-LagoMTirapuJ: Construct validity of the Trail Making Test: role of task-switching, working memory, inhibition/interference control, and visuomotor abilities. J Int Neuropsychol Soc15:438–4502009
SolanaEPocaMASahuquilloJBenejamBJunquéCDronavalliM: Cognitive and motor improvement after retesting in normal-pressure hydrocephalus: a real change or merely a learning effect?J Neurosurg112:399–4092010