TY - JOUR
T1 - Predictors of Postoperative Visual Outcome After Surgical Intervention for Craniopharyngiomas
AU - Kopparapu, Srujan
AU - Khalafallah, Adham M.
AU - Botros, David
AU - Carey, Andrew R.
AU - Rodriguez, Fausto J.
AU - Duan, Daisy
AU - Rowan, Nicholas R.
AU - Mukherjee, Debraj
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/4
Y1 - 2021/4
N2 - 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.
AB - 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.
KW - Craniopharyngioma
KW - Neurosurgery
KW - Predictors
KW - Vision
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UR - http://www.scopus.com/inward/citedby.url?scp=85100637083&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2021.01.044
DO - 10.1016/j.wneu.2021.01.044
M3 - Article
C2 - 33482413
AN - SCOPUS:85100637083
SN - 1878-8750
VL - 148
SP - e589-e599
JO - World neurosurgery
JF - World neurosurgery
ER -