Abstract
Purpose: To predict the prognosis of craniopharyngioma in children by optical coherence tomography angiography (OCTA).Methods: We evaluated if the relationship between preoperative OCTA of the choroidal capillary density (CCD) and visual outcome continued over long-term visual recovery in 38 patients undergoing craniopharyngioma resection. Patients were evaluated 3 times: 1 week before surgery (Visit1), followed-up at 6–10 weeks (Visit2), and 9–15 months (Visit3) after surgery.Results: In total 38 patients (70 eyes) with craniopharyngiomas, which included 20 (52.6%) boys and 18 (47.4%)girls, the mean age was 11.8 ± 2.7 years (range: 6–18 years). The age (p = 0.71), gender (p = 1.00), mean refractive error (p = 0.55), and axial length (p = 0.23) of 38 normal volunteers (76 eyes) were matched. After surgery, the cross-compression of patients was relieved. The average visual acuity change in the normal CCD group was 0.07 ± 0.02; the average visual acuity change in the low CCD group was 0.01 ± 0.01, p < 0.001. Preoperative CCD value is related to the preoperative BCVA (p < 0.001), and the visual function after the long-term follow-up (9–15 months) (p < 0.001). The prognosis of CCD has the same trend as the BCVA. Further correlation analysis shows that CCD and BCVA are significantly correlated (r = 0.878; p < 0.001). CCD has a weak but significant correlation both with MD (r = 0.19; p < 0.001) and PSD (r = −0.21; p <0.001). A natural cutoff of CCD is approximately 38%. With the normal CCD group the maximum improvement of BCVA exceeds 0.3 post-operatively, compared to eyes in the low CCD group that improve by <0.03, and worse after surgery.Conclusions: Long-term vision recovery after surgical decompression of craniopharyngiomas in children can be predicted by preoperative by OCTA. Patients with normal CCD before surgery showed a tendency to improve vision; this trend of improvement persisted in subsequent follow-ups. The CCD baseline natural cutoff value for predicting visual prognosis before and after surgery is about 38%.
Highlights
Craniopharyngioma, which develops from the remnant epithelial cells of the craniopharyngeal duct formed by the primitive ectoderm during the embryonic period, is the most common intracranial congenital tumor and has the second-highest incidence of all tumors in the sella area [1]
We evaluated if the relationship between preoperative optical coherence tomography angiography (OCTA) of the choroidal capillary density (CCD) and visual outcome continued over long-term visual recovery in 38 patients undergoing craniopharyngioma resection
Preoperative CCD value is related to the preoperative bestcorrected visual acuity (BCVA) (p < 0.001), and the visual function after the long-term follow-up (9–15 months) (p < 0.001)
Summary
Craniopharyngioma, which develops from the remnant epithelial cells of the craniopharyngeal duct formed by the primitive ectoderm during the embryonic period, is the most common intracranial congenital tumor and has the second-highest incidence of all tumors in the sella area [1]. The overwhelming majority of craniopharyngiomas affect visual acuity, and the prognosis of visual acuity after surgery is unpredictable. For patients with visually impaired craniopharyngioma, timely and effective surgical resection can restore vision in some patients, but there are still some patients with visual impairment [4]. There is an urgent need for accurate and feasible visual predictive quantitative indicators to determine the prognosis of patients’ visual function before surgery, to assist the selection of surgical timing and strategies. Researchers are committed to determining preoperative characteristic indicators to predict vision recovery for craniopharyngioma. Duration of symptoms, tumor size and volume, preoperative visual acuity (VA) or visual field impairment (VF), optic nerve atrophy, and electroretinogram have all been studied, but none of them can accurately and consistently predict postoperative visual function for the limitations of subjectivity and difficulty in cooperation [5]
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