Longitudinal Analysis of Visual Outcomes After Surgical Treatment of Adult Craniopharyngiomas

Abstract

Short-term VD secondary to the surgical insult and the recurrence of the tumor were strong predictors of long-term visual outcomes after surgical treatment for CRP. STR alone may be an ineffective strategy for achieving tumor control and optimal visual outcomes in patients with CRP.

Optic Chiasm Distortions Caused by Craniopharyngiomas: Clinical and Magnetic Resonance Imaging Correlation and Influence on Visual Outcome

“…Intraoperative injury of the optic chiasm is considered the major cause for the immediate visual deterioration after surgery and a predictor of a bad long-term visual outcome (11,28,62,82,117,127,135). Manipulating a much distorted chiasm is especially harmful and, for this reason, tumor cyst drainage to decompress the optic chiasm has been recommended first to allow the visual function to improve before performing the tumor resection (99).…”

“…For this reason, the presence of visual disturbances has been considered a prime indication for the treatment of CPs (28). Recovery of normal vision after the CP removal is a major determinant of the patient's quality of life (62,65,121). Nevertheless, variability in the degree of visual recovery that occurs following a CP surgery makes impossible to predict the specific outcome of a particular patient.…”

“…The predictive factors for the severity of preoperative visual disturbances and for the visual outcome after CP surgery are still not completely defined (1,18,62,105). Nowadays the preoperative vision status is acknowledged to be a major determinant factor in the final visual outcome of patients with CPs, yet no studies have analyzed thoroughly the influence that morphological distortions of the visual pathways caused by CPs has in the final visual outcome.…”

Optic nerve mobilization to enhance the exposure of the pituitary stalk during craniopharyngioma resection: early experience

“…Although patients with intrasellar craniopharyngiomas usually have hormonal disturbances at the time of presentation, in patients with supradiaphragmatic craniopharyngioma, the visual symptoms dominate. 1,2,4,[8][9][10][11][12][13][14][15][16][17][18]20,24,[32][33][34][35] The choice of operative approach for craniopharyngioma resection depends on the surgeon's preference and experience, considering the location and configuration of the tumor. Our current concept of management of craniopharyngiomas is gross-total resection via the frontolateral approach.…”

“…The major challenge that remains is the intraoperative identification and preservation of the pituitary stalk with its feeding vessels, especially in large supradiaphragmatic craniopharyngiomas. 1,2,4,[8][9][10][11][12][13][16][17][18]20,24,33 In this article, we describe a technique that enhances tumor resection while preserving the pituitary stalk. It includes unroofing of the optic canal together with incision of the falciform ligament and drilling of the lateral part of the tuberculum sellae.…”