NEUROBEHAVIORAL OUTCOME IN PEDIATRIC CRANIOPHARYNGIOMA

Neurobehavioral dysfunction occurs in children with craniopharyngioma, both before and after treatment, and its impact on outcome may not be fully appreciated. Also unclear is whether neurobehavioral outcome re lates more to tumor location or surgical factors. We reviewed the reco rds of 20 children with craniopharyngioma who were seen between 1983 a nd 1995. All children had subfrontal craniotomy and either partial (14 children) or gross total (6 children) resection of their tumors. In a ddition to traditional neuropsychological testing, we assessed social behavior and school performance using standardized ratings based on fa mily interviews and school records. Over a mean follow-up period of 38 months, only 3 of 20 children had a good outcome in all three categor ies, and 12 of 20 had moderate or severe impairment in at least one ca tegory. Outcome did not differ between those who had partial and those with gross total resection. We conclude that neurobehavioral disorder s are common and cause important morbidity in children after treatment for craniopharyngioma. To evaluate these impairments in future outcom e studies, standard neuropsychological testing should be supplemented by specific behavioral assessments to capture the full range of neurob ehavioral disability. In this series, partial versus gross total resec tion did not influence outcome, implying that tumor location in dience phalic and limbic regions is a more important factor.