Surgical approach to children with craniopharyngiomas and severely impaired vision: special considerations.

A series of 30 children with craniopharyngiomas is presented, analyzing visual sequelae following surgery. All were operated on with the goal of total removal. Surgical routes used were subfrontal prechiasmatic or translamina terminalis, pterional interopticocarotid, transcallosal, or a combination of these various avenues. The choice of the approach depended upon the type, pre- or retrochiasmatic, of the tumor expansions. Children with large cysts and preoperatively low vision, or vision at risk of rapid deterioration, were submitted to a protocol aiming to preoperatively decompress the visual pathway by repeated aspirations 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 stable new level. The authors emphasize the interest of this procedure in reducing the rate of postoperative visual sequelae. However, they also point out that the interopticocarotid route carries a nonnegligible risk of postoperative visual worsening.