SURGICAL APPROACH TO CHILDREN WITH CRANIOPHARYNGIOMAS AND SEVERELY IMPAIRED VISION - SPECIAL CONSIDERATIONS

A series of 30 children with craniopharyngiomas is presented, analyzin g visual sequelae following surgery. All were operated on with the goa l of total removal. Surgical routes used were subfrontal prechiasmatic or translamina terminalis, pterional interopticocarotid, transcallosa l, or a combination of these various avenues. The choice of the approa ch depended upon the type, pre- or retrochiasmatic, of the tumor expan sions. Children with large cysts and preoperatively low vision, or vis ion at risk of rapid deterioration, were submitted to a protocol aimin g to preoperatively decompress the visual pathway by repeated aspirati ons of the cyst with the hope this would improve vision before surgery and limit risks of postoperative visual deterioration. In these cases , the removal of the tumor was postponed until vision had reached a st able new level. The authors emphasize the interest of this procedure i n reducing the rate of postoperative visual sequelae. However, they al so point out that the interopticocarotid route carries a nonnegligible risk of postoperative visual worsening.