The ophthalmic natural history of paediatric craniopharyngioma: a long-term review

Drimtzias, Evangelos; Falzon, Kevin; Picton, Susan; Jeeva, Irfan; Guy, Danielle; Nelson, Olwyn; Simmons, Ian

doi:10.1007/s11060-014-1600-5

Cited by 33 publications

(26 citation statements)

References 27 publications

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“…This rate is similar to that reported previously. 1,14,25 More frequent than decreased acuity was the presence of a visual field defect, which is consistent with the higher prevalence of decreased mean RNFL thickness as compared with temporal RNFL damage that we observed. In our case series, only one out of eight tested cases showed normal visual fields.…”

Section: Discussionsupporting

confidence: 90%

Visual Outcomes, Visual Fields, and Optical Coherence Tomography in Paediatric Craniopharyngioma

Mediero

Noval

Bravo-Ljubetic

et al. 2015

Neuro-Ophthalmology

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Ten patients with craniopharyngioma treated for the first time when younger than 18 were included. This study reviews the visual outcomes and provides information on visual field (VF) and optical coherence tomography (OCT) examination of craniopharyngioma. The best kappa concordance coefficients between VF and OCT parameters of atrophy were obtained for the ganglion cell (GC) thickness and the mean retinal nerve fibre layer (RNFL) thickness. The agreement between GC colour maps and VF defects was good. Optic nerve compression may be detected by RNFL measurement and GC analysis, and this may be valuable to predict visual recovery and in uncooperative patients to evaluate visual damage.

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Section: Discussionsupporting

confidence: 90%

Visual Outcomes, Visual Fields, and Optical Coherence Tomography in Paediatric Craniopharyngioma

Mediero

Noval

Bravo-Ljubetic

et al. 2015

Neuro-Ophthalmology

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“…The number of patients with papilledema in both groups was much lower than that in case series of other pediatric cerebral tumors and craniopharyngioma. 1,4,10 Finally, and in accordance with these previous reports, the incidence of optic atrophy after treatment was higher than at diagnosis. This study has some limitations.…”

Section: Discussionsupporting

confidence: 90%

“…This type of simple global score was previously proposed as a way to evaluate the ophthalmological history of pediatric patients with craniopharyngioma. 4 It has the advantage of allowing easy comparison of pre-and postoperative examinations of each patient and between groups. Other data, like visual evoked potential, color and contrast vision, and retinal nerve fiber layer thickness as determined by optical coherence tomography, may also be used in the future to better understand this edema.…”

Section: Discussionmentioning

confidence: 99%

Edema of the optic tract in patients with tumors of the sellar region: clinical and visual implications in the pediatric population

Bussat¹,

Proisy

Bruneau

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVETumor-related edema of the optic tract (EOT) corresponds to a preferential posterior distribution of peritumoral edema along the white matter tract of the visual system. To date, the consequences of EOT have never been evaluated specifically in the pediatric population. In this study, the authors attempted to identify clinical and radiological features associated with the development of EOT and the specific influence of this edema on visual function.METHODSA retrospective review was performed of data collected from patients younger than 18 years who underwent surgery for a tumor in the sellar region at the authors’ institution between January 2005 and January 2016. Data were collected on patient characteristics, ophthalmological evaluations, and neuroimaging findings. To evaluate and compare visual function impairment, ophthalmological data were converted to a global visual function score, which took into account visual acuity, visual field evaluations, and laterality deficiencies. The visual acuity score was defined according to the International Classification of Diseases, 10th Revision. Visual field deficiencies were converted to a score of 0–2. Two opposing groups were then distinguished according to the presence or absence of EOT. Visual acuity, visual field results, and global scores were compared between groups before and after treatment.RESULTSTwenty-six patients were included in the study: 17 patients with craniopharyngioma, 3 patients with pilocytic astrocytoma, 2 patients with ganglioglioma, 2 patients with germ cell tumor, 1 patient with macroprolactinoma, and 1 patient with Rathke’s cleft cyst. There were 11 children in the group with edema and 15 children in the group without edema. None of the following criteria were statistically different between the 2 groups: age, sex, clinical symptoms at presentation (endocrine deficiency or intracranial hypertension signs), incidence of hydrocephalus, compression of the optic tracts and mass effect on the optic chiasm, tumor size and localization, presence of intratumoral cysts, treatment, type of tumor, or recurrence. The median global visual function and visual acuity scores were not significantly different between the groups either at presentation or at final evaluation. The visual field score was lower (i.e., more deficiency) in the group with edema than in the group without edema (p < 0.05); 89% of the patients with edema had severe or mild visual field impairment versus only 40% of the patients without edema. At the final examination after treatment, the visual field scores were not different between the 2 groups. Although not significant, the number of patients with optic disc pallor was greater in the group without edema both at diagnosis and at final examination.CONCLUSIONSThis study confirms that EOT in the context of sellar region tumor in children is not necessarily associated with a less-favorable visual prognosis.

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“…This energy intake/REE ratio was significantly lower in those with tumours involving the third ventricle [ 81 ]. Further, factors that could potentially contribute to decreased physical activity are neurological and visual deficits [ 82 , 83 ], increased daytime sleepiness [ 74 , 78 ], and psychosocial difficulties [ 75 ].…”

Section: Hypothalamic Obesitymentioning

confidence: 99%

Craniopharyngioma and hypothalamic injury

Müller

2016

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of reviewHypothalamic alterations, pathological or treatment induced, have major impact on prognosis in craniopharyngioma patients mainly because of consequent hypothalamic obesity. Recent insight in molecular genetics, treatment strategies, risk factors and outcomes associated with hypothalamic obesity provide novel therapeutic perspectives. This review includes relevant publications since 2013.Recent findingsRecent findings confirm that alterations in posterior hypothalamic areas because of tumour location and/or treatment-related injuries are associated with severe hypothalamic obesity, reduced overall survival and impaired quality of life in long-term survivors of childhood-onset craniopharyngioma. However, eating disorders are observed because of hypothalamic obesity without clear disease-specific patterns. Treatment options for hypothalamic obesity are very limited. Treatment with invasive, nonreversible bariatric methods such as Roux-en-Y gastric bypass is most efficient in weight reduction, but controversial in the paediatric population because of medical, ethical, and legal considerations. Accordingly, treatment in craniopharyngioma should focus on prevention of (further) hypothalamic injury. Presurgical imaging for grading of hypothalamic involvement should be the basis for hypothalamus-sparing strategies conducted by experienced multidisciplinary teams.SummaryUntil a nonsurgical therapeutic option for hypothalamic obesity for paediatric patients is found, prevention of hypothalamic injury should be the preferred treatment strategy, conducted exclusively by experienced multidisciplinary teams.

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The ophthalmic natural history of paediatric craniopharyngioma: a long-term review

Cited by 33 publications

References 27 publications

Visual Outcomes, Visual Fields, and Optical Coherence Tomography in Paediatric Craniopharyngioma

Visual Outcomes, Visual Fields, and Optical Coherence Tomography in Paediatric Craniopharyngioma

Edema of the optic tract in patients with tumors of the sellar region: clinical and visual implications in the pediatric population

Craniopharyngioma and hypothalamic injury

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