Predictors of Postoperative Visual Outcome After Surgical Intervention for Craniopharyngiomas

Srujan Kopparapu; Adham M Khalafallah; David Botros; Andrew R Carey; Fausto J Rodriguez; Daisy Duan; Nicholas R Rowan; Debraj Mukherjee

doi:10.1016/j.wneu.2021.01.044

Predictors of Postoperative Visual Outcome After Surgical Intervention for Craniopharyngiomas

World Neurosurg. 2021 Apr:148:e589-e599. doi: 10.1016/j.wneu.2021.01.044. Epub 2021 Jan 20.

Authors

Srujan Kopparapu¹, Adham M Khalafallah¹, David Botros¹, Andrew R Carey², Fausto J Rodriguez³, Daisy Duan⁴, Nicholas R Rowan⁵, Debraj Mukherjee⁶

Affiliations

¹ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
² Department of Neuro-Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
³ Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁴ Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁵ Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁶ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address: dmukher1@jhmi.edu.

PMID: 33482413
DOI: 10.1016/j.wneu.2021.01.044

Abstract

Background: Because of involvement of the optic apparatus, craniopharyngiomas frequently present with visual deterioration. Although visual improvement is a primary goal of surgical intervention, prediction models are lacking.

Methods: We retrospectively reviewed all patients undergoing craniopharyngioma surgery at a single institution (2014-2019). Preoperative, intraoperative, and postoperative variables of interest were collected. Visual acuity and visual fields (VFs) were standardized into Visual Impairment Scores (VISs), defined by the German Ophthalmological Society. VIS ranged from 0 (normal vision) to 100 (complete bilateral blindness). Visual improvement/deterioration was defined as a postsurgical decrease/increase of ≥5 VIS points, respectively.

Results: Complete ophthalmologic assessments were available for 61 operations, corresponding to 41 patients (age, 4-73 years). Vision improved after 28 operations (46%), remained stable after 27 (44%), and deteriorated after 6 (10%). In bivariate analysis, significant predictors of visual improvement included worse preoperative VIS (odds ratio [OR], 1.058; P < 0.001), worse preoperative VF mean deviation (OR, 1.107; P = 0.032), preoperative vision deficits presenting for longer than 1 month (OR, 6.050; P = 0.010), radiographic involvement of the anterior cerebral arteries (OR, 3.555; P = 0.019), and gross total resection (OR, 4.529; P = 0.022). The translaminar surgical approach was associated with visual deterioration (OR, 6.857; P = 0.035). In multivariate analysis, worse preoperative VIS remained significantly associated with postoperative visual improvement (OR, 1.060; P = 0.011). Simple linear correlation (R²=0.398; P < 0.001) suggests prediction of postoperative VIS improvement via preoperative VIS.

Conclusions: Patients with reduced preoperative vision, specific radiographic vascular involvement, and gross total resection showed increased odds of visual improvement, whereas the translaminar approach was associated with visual deterioration. Such characteristics may facilitate patient-surgeon counseling and surgical decision making.

Keywords: Craniopharyngioma; Neurosurgery; Predictors; Vision.

MeSH terms

Adolescent
Adult
Aged
Child
Child, Preschool
Color Vision
Craniopharyngioma / complications
Craniopharyngioma / surgery*
Female
Humans
Male
Middle Aged
Neurosurgical Procedures / methods*
Pituitary Neoplasms / complications
Pituitary Neoplasms / surgery*
Predictive Value of Tests
Retrospective Studies
Treatment Outcome
Vision Disorders / etiology*
Vision Disorders / surgery*
Vision Tests
Visual Acuity
Visual Fields
Young Adult