gms | German Medical Science

Objective: Craniopharyngiomas are rare and benign tumors of the sellar and/or the parasellar region. Primary treatment involves surgical resection followed by adjuvant radiotherapy. Despite successful therapy, patients often show neuropsychological deficits and impaired quality of life (Qol). The causal influence of specific anatomical structures is so far unclear. An affection of the fornix and/or the mammillary body (MB) appear to be probable and were therefore analyzed in the present work.

Methods: In total, we included 71 patients (39 male, 32 female), with a mean age of 49 years, in our retrospective analysis. In addition, 36 out of the 71 patients prospectively received a detailed neurological and neuropsychological testing as well as an assessment of the Qol (SF-36).

Results: In total, 75% of patients showed neuropsychological deviations in at least one test-item. In particular, attentiveness, cognitive speed and short-term memory was affected. 63.9% of patients showed a significantly reduced Qol during the follow up. As risk factors, we could identify a tumor volume larger than 9ccm, tumor extension toward/into the 3rd ventricle and surgical resection using a bifrontal lamina terminalis or a left-sided approach. If the tumor involved the MB, patients showed significantly (p=0.01) worse results in terms of short-term memory and attention. Patients with tumors involving the fornix predominantly showed abnormalities in learning performance and short-term memory.

Conclusion: In the present study, we demonstrated that resection of craniopharyngiomas is frequently associated with postoperative neuropsychological deficits and an impaired Qol. In addition to tumor size, extension and surgical approach, the involvement of the MB and the fornix are negative influencing factors. Patients significantly show more impairments in short-term memory, attention, and learning performance.