Neuropsychological follow-up of twenty two adult patients after surgery for craniopharyngioma

The optimal management of craniopharyngioma today remains an unconcluded de bate. This prospective study examines the cognitive status and quality of l ife of 22 patients one year after surgery for craniopharyngioma. Pterional approach (5 left, 15 right) was used in 20 patients (90%), wherea s two were operated on using a rhinoseptal approach. Neuropsychological examination was performed twelve months after the operat ion. For twelve patients, neuropsychological examination was performed befo re operation. The preoperative evaluation revealed that six patients had impaired neurops ychological testing with memory and frontal dysfunction. Four of these pati ents have no postoperative neuropsychological defect. After surgery, there were 5 patients in whom abnormalties could be detected on the extended psychometric assessment: two were severe (a Korsakoff's sy ndrome and a memory defect associated with an intellectual deterioration), and three moderate (recent memory defects with frontal dysfunction, isolate d learning defects). Four patients of the 22 were not able to return to the ir pre-illness activity. The present evaluation emphasizes that a good quality of life and neuropsyc hological performance were maintained in the majority of patients. Preopera tive frontal dysfunction is probably correlated to tumour location, and pre cisely to the interruption of the direct efferent projections from the fron tal cortex to the hypothalamus. Postoperative alterations of neuropsychological function were noticed only in patients with pterional approach. These patients had a poor surgical out come, preoperative neuropsychological defects or treatment combined with ra diotherapy. The two patients who were operated on using a rhinoseptal appro ach had no neuropsychological deficit. But this surgical approach is best r eserved for patients with smaller intrasellar tumours. Further studies are needed to evaluate the neuropsychological advantage of these different appr oaches.