NEUROPSYCHOLOGICAL RESULTS OF CRANIOPHARYNGIOMA SURGERY IN ADULTS - APROSPECTIVE-STUDY

BACKGROUND. The optimal management of craniopharyngiomas is a topic of ongoing debate. Supporters of limited surgery for craniopharyngiomas claim that more radical approaches are afflicted with adverse neuropsy chological sequelae. Since prospective studies on this issue have not yet been performed, we assessed neuropsychological functioning in adul ts before and after craniopharyngioma surgery. METHODS. Thirteen adult s with an age range of 17-76 years (mean, 45 years) were included in t he study. Surgery included a transcranial procedure in 10 patients. Th e bifrontal interhemispheric approach predominated (n = 7). Neuropsych ological evaluation was performed before and 3 months after surgery. T he test battery was adjusted to evaluate function related to structure s in the operative trajectory and at the tumor site. RESULTS. A comple te tumor removal was accomplished in eight patients and subtotal remov al in three patients. IQ scores for verbal intelligence were in the no rmal range and not affected by surgery (mean IQ score preoperative: 10 6.8; postoperative 107.4). In 12 of 13 patients, immediate recall, del ayed recall and recognition memory were not impaired after surgery. Po stoperative results for abstract thinking were in the normal or above- normal range. Cognitive speed was impaired in three patients preoperat ively and in two patients postoperatively. Overall results were signif icantly better after surgery. Word fluency was not affected by surgery . Quality of life for the category ''sleep'' was impaired preoperative ly, and this improved after surgery. Otherwise, quality of life was no rmal both before and after surgery. CONCLUSIONS. Neuropsychological pe rformance and quality of life are generally not impaired after surgica l removal of craniopharyngiomas. The findings support the attitude tha t the initial therapy of craniopharyngiomas should be an attempt at to tal removal. (C) 1998 by Elsevier Science Inc.