Article
Neurological and neuropsychological outcome after surgical treatment of craniopharyngiomas in adults
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Authors
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Henrik Giese
- Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
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Benjamin Hänig
- Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
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Andreas W. Unterberg
- Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
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Klaus Zweckberger
- Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: Craniopharyngiomas are rare and benign tumors of the sellar and/or the parasellar region. Primary treatment involves surgical resection followed by adjuvant radiotherapy. While the grade of resection was frequently analyzed following surgery, the neurological outcome and, in particular neuropsychological deficits and the quality of life were neglected for many decades. Therefore, we retrospectively analyzed our series and prospectively assessed the neuropsychological outcome and the quality of life following surgical resection of craniopharyngiomas in adults.
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 quality of life (SF-36). Factors influencing outcome were identified and correlations calculated using correlation analyses.
Results: Surgical resection was performed using a pterional (41.6%) or bifrontal lamina terminalis (30%) approach. Following surgery, visual acuity was significantly improved (> 0.2 dpt.) in 23 or remained stable in 32 patients. During the long-term follow up, 80% of patients developed pituitary insufficiency, especially involving the corticotropic and thyrotrophic axis. 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. Referring to the SF-36 score, quality-of-life was affected addressing both, the mental and physical score in 19.4% and 33.3% of patients, respectively. As risk factors, we could identify a tumor volume larger than 9 ccm, tumor extension toward/into the 3rd ventricle and surgical resection using a bifrontal lamina terminalis or a left-sided approach.
Conclusion: In the present study, we demonstrated that resection of craniopharyngiomas is frequently associated with postoperative neuropsychological deficits and an impaired quality of life. In addition to the tumor size and the extension towards/into the third ventricle, the selection of the surgical approach plays a crucial role in the patient's neuropsychological outcome and quality of life.
