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.
CavalloLM, FrankG, CappabiancaP, SolariD, MazzatentaD, VillaA, : The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients. 121:100–113, 201410.3171/2014.3.JNS13152124785324)| false
De VileCJ, GrantDB, KendallBE, NevilleBG, StanhopeR, WatkinsKE, : Management of childhood craniopharyngioma: can the morbidity of radical surgery be predicted?85:73–81, 199610.3171/jns.1996.85.1.0073)| false
Di PintoM, ConklinHM, LiC, MerchantTE: Learning and memory following conformal radiation therapy for pediatric craniopharyngioma and low-grade glioma. 84:e363–e369, 201210.1016/j.ijrobp.2012.03.066)| false
DuC, FengCY, YuanXR, LiuQ, PengZF, JiangXJ, : Microsurgical management of craniopharyngiomas via a unilateral subfrontal approach: a retrospective study of 177 continuous cases. 90:454–468, 201610.1016/j.wneu.2016.03.002)| false
FedorkoS, ZweckbergerK, UnterbergAW: Quality of life following surgical treatment of lesions within the pineal region. [epub ahead of print February 1, 2018. DOI: 10.3171/2017.7.JNS17260]29498568)| false
FernándezAL, MarcopulosBA: A comparison of normative data for the Trail Making Test from several countries: equivalence of norms and considerations for interpretation. 49:239–246, 200810.1111/j.1467-9450.2008.00637.x18419589)| false
FjalldalSHolmerHRylanderLElfvingMEkmanBÖsterbergK: Hypothalamic involvement predicts cognitive performance and psychosocial health in long-term survivors of childhood craniopharyngioma. J Clin Endocrinol Metab98:3253–32622013
HofmannBM, HölligA, StraussC, BusleiR, BuchfelderM, FahlbuschR: Results after treatment of craniopharyngiomas: further experiences with 73 patients since 1997. 116:373–384, 20122194272410.3171/2011.6.JNS081451)| false
KaravitakiN, BrufaniC, WarnerJT, AdamsCBT, RichardsP, AnsorgeO, : Craniopharyngiomas in children and adults: systematic analysis of 121 cases with long-term follow-up. 62:397–409, 200510.1111/j.1365-2265.2005.02231.x15807869)| false
KaufmannLZierenNZotterSKarallDScholl-BürgiSHaberlandtE: Predictive validity of attentional functions in differentiating children with and without ADHD: a componential analysis. Dev Med Child Neurol52:371–3782010
KaufmannL, ZierenN, ZotterS, KarallD, Scholl-BürgiS, HaberlandtE, : Predictive validity of attentional functions in differentiating children with and without ADHD: a componential analysis. 52:371–378, 20102005951110.1111/j.1469-8749.2009.03560.x)| false
KomotarRJ, StarkeRM, RaperDMS, AnandVK, SchwartzTH: Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of craniopharyngiomas. 77:329–341, 201210.1016/j.wneu.2011.07.01122501020)| false
McGrathJ, ScheldtS, WelhamJ, ClairA: Performance on tests sensitive to impaired executive ability in schizophrenia, mania and well controls: acute and subacute phases. 26:127–137, 199710.1016/S0920-9964(97)00070-49323343)| false
MemmesheimerRM, LangeK, DölleM, HegerS, MuellerI: Psychological well-being and independent living of young adults with childhood-onset craniopharyngioma. 59:829–836, 20172848551610.1111/dmcn.13444)| false
MortimerD, SegalL: Comparing the incomparable? A systematic review of competing techniques for converting descriptive measures of health status into QALY-weights. 28:66–89, 200810.1177/0272989X0730964218263562)| false
MortiniP, LosaM, PozzobonG, BarzaghiR, RivaM, AcernoS, : Neurosurgical treatment of craniopharyngioma in adults and children: early and long-term results in a large case series. 114:1350–1359, 201110.3171/2010.11.JNS10670)| false
MüllerH, Hasse-SanderI, HornR, HelmstaedterC, ElgerCE: Rey Auditory-Verbal Learning Test: structure of a modified German version. 53:663–671, 199710.1002/(SICI)1097-4679(199711)53:7<663::AID-JCLP4>3.0.CO;2-J9356896)| false
OndruchA, MaryniakA, KropiwnickiT, RoszkowskiM, DaszkiewiczP: Cognitive and social functioning in children and adolescents after the removal of craniopharyngioma. 27:391–397, 20112093120410.1007/s00381-010-1301-0)| false
PereiraAMSchmidEMSchuttePJVoormolenJHCBiermaszNRvan ThielSW: High prevalence of long-term cardiovascular, neurological and psychosocial morbidity after treatment for craniopharyngioma. Clin Endocrinol (Oxf)62:197–2042005
PereiraAM, SchmidEM, SchuttePJ, VoormolenJHC, BiermaszNR, van ThielSW, : High prevalence of long-term cardiovascular, neurological and psychosocial morbidity after treatment for craniopharyngioma. 62:197–204, 200510.1111/j.1365-2265.2004.02196.x15670196)| false
PeroS, IncocciaC, CaraccioloB, ZoccolottiP, FormisanoR: Rehabilitation of attention in two patients with traumatic brain injury by means of ‘attention process training’. 20:1207–1219, 20061712393710.1080/02699050600983271)| false
PorettiA, GrotzerMA, RibiK, SchönleE, BoltshauserE: Outcome of craniopharyngioma in children: long-term complications and quality of life. 46:220–229, 200410.1111/j.1469-8749.2004.tb00476.x15077699)| false
RodewaldK, BartolovicM, DebelakR, AschenbrennerS, WeisbrodM, Roesch-ElyD: Eine Normierungsstudie eines modifizierten Trail Making Tests im deutschsprachigen Raum. 23:37–48, 201210.1024/1016-264X/a000060)| false
RothmannK, HillmerJM, HosserD: [Evaluation of the musical concentration training with Pepe (MusiKo mit Pepe) for children with attention deficits.] 42:325–335, 2014(Ger)10.1024/1422-4917/a00030825163995)| false
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
Sánchez-CubilloI, PeriáñezJA, Adrover-RoigD, Rodríguez-SánchezJM, Ríos-LagoM, TirapuJ, : Construct validity of the Trail Making Test: role of task-switching, working memory, inhibition/interference control, and visuomotor abilities. 15:438–450, 200910.1017/S135561770909062619402930)| false
SolanaEPocaMASahuquilloJBenejamBJunquéCDronavalliM: Cognitive and motor improvement after retesting in normal-pressure hydrocephalus: a real change or merely a learning effect?J Neurosurg112:399–4092010
SolanaE, PocaMA, SahuquilloJ, BenejamB, JunquéC, DronavalliM: Cognitive and motor improvement after retesting in normal-pressure hydrocephalus: a real change or merely a learning effect?112:399–409, 20101948053910.3171/2009.4.JNS081664)| false
ZadaG, KintzN, PulidoM, AmezcuaL: Prevalence of neurobehavioral, social, and emotional dysfunction in patients treated for childhood craniopharyngioma: a systematic literature review. 8:e76562, 201310.1371/journal.pone.007656224223703)| false