Long-Term Visual Outcomes of Craniopharyngioma in Children
The Hospital for Sick Children and The University of Toronto
Toronto, Ontario, Canada
Introduction: Craniopharyngiomas in children commonly cause visual impairment. The purpose of this study is to report long-term visual outcomes in a cohort of pediatric craniopharyngioma patients.
Methods: The study design is a retrospective chart review of craniopharyngioma patients from a single tertiary care pediatric hospital.
Results: 50 patients were included in the study. Median age at presentation was 10.2 years old (range 0.7 – 18.0 years old). The most common presenting features were headache (74%), vision loss (32%), and nausea/vomiting (30%). At presentation, 42% had optic nerve pallor and 42% had optic nerve edema. Median follow-up was 4.5 years. During follow-up, 67% of patients had a recurrence requiring treatment and 32% of patients had at least one episode of sudden visual decline. At last follow-up, 60% of patients had moderate visual impairment in at least one eye (<20/40 or more than 50% visual field loss), 28% had moderate binocular visual impairment, and 12% of patients had severe binocular visual impairment (<20/200 or less than 20 degrees of visual field in the better eye).
Discussion: Vision loss is a common presenting symptom of craniopharyngiomas in children, and key diagnostic findings include optic nerve pallor and edema. After diagnosis, monitoring vision is important as sudden visual decline is a common indicator of recurrence. Vision loss occurs in the majority of patients, but severe binocular visual impairment is uncommon.
Conclusion: Craniopharyngioma is a potentially blinding disease in children. Visual symptoms and ophthalmological exam findings are important in the diagnosis, prognosis, and monitoring of affected children.
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