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

The optimal management of craniopharyngioma today remains an unconcluded debate. This prospective study examines the cognitive status and quality of life of 22 patients one year after surgery for craniopharyngioma. Pterional approach (5 left, 15 right) was used in 20 patients (90%), whereas two were operated on using a rhinoseptal approach. Neuropsychological examination was performed twelve months after the operation. For twelve patients, neuropsychological examination was performed before operation. The preoperative evaluation revealed that six patients had impaired neuropsychological testing with memory and frontal dysfunction. Four of these patients have no postoperative neuropsychological defect. After surgery, there were 5 patients in whom abnormalities could be detected on the extended psychometric assessment: two were severe (a Korsakoff's syndrome and a memory defect associated with an intellectual deterioration), and three moderate (recent memory defects with frontal dysfunction, isolated learning defects). Four patients of the 22 were not able to return to their pre-illness activity. The present evaluation emphasizes that a good quality of life and neuropsychological performance were maintained in the majority of patients. Preoperative frontal dysfunction is probably correlated to tumour location, and precisely to the interruption of the direct efferent projections from the frontal cortex to the hypothalamus. Postoperative alterations of neuropsychological function were noticed only in patients with pterional approach. These patients had a poor surgical outcome, preoperative neuropsychological defects or treatment combined with radiotherapy. The two patients who were operated on using a rhinoseptal approach had no neuropsychological deficit. But this surgical approach is best reserved for patients with smaller intrasellar tumours. Further studies are needed to evaluate the neuropsychological advantage of these different approaches.