Predictors of Treatment Outcomes in Patients with Craniopharyngioma Surgically Treated at Two Teaching Hospitals Addis Ababa,Ethiopia: A 10 Year Retrospecive Cohort Study From Jan2013-Jan2023.
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Date
2023-11
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Addis Ababa University
Abstract
Background: Craniopharyngioma is a rare disabling disease due to its malignant behavior
though it’s histologically benign. The bulk of literatures that describe treatment strategies and
treatment outcomes of patients with craniopharyngioma are from westerns and the long term
neurological, endocrinological, ophthalmological and psychosocial outcomes are not well
studied in developing countries.
Objective: The aim of this study was to assess neurological, ophthalmological, endocrinological
and overall functional outcomes of patients with craniopharyngioma at TASH and MCM
comprehensive specialized hospitals from Jan 2013 to Jan 2023.
Methodology: Retrospective cohort study was conducted to assess the predictors of treatment
outcome of patients with craniopharyngioma was undertaken at TASH and MCM hospitals in
Addis Ababa, Ethiopia which are affiliated Neurosurgical hospitals. The long term neurological,
ophthalmological, endocrinologic and general functional outcomes of patients treated for the past
10 years from Jan 2013 to Jan 2023 was studied. Data was collected by chart review and via
phone contact to the patients. The MRI/CT image was re-evaluated when available. The
neurological, ophthalmological, endocrinological and overall functional outcomes were
analyzed. The functional independence and Craniopharyngioma clinical status scale (CCSS) was
used to assess the overall functional status of patients. Factors affecting the functional outcome
were identified and correlations were performed using SPSS Version 25.
Results: Among 40 patients included in the study headache (95%, 38/40), visual deterioration
(87.5%, 35/40) and lethargy (85%, 34/40) were the most common presentations. Thyroxine and
cortisol were the most deficient hormones preoperatively (35%, 14/40) and (32.5%, 13/40)
respectively. Pre operative DI was present in 35% of the patients. Craniotomy was done in (70
%, 28/40) and trans nasal surgery for (22.5%, 9/40) of patients, VPS for (5%, 2/40) and EVD for
(2.5%, 1/40) patients. STR was done in (60%, 24/40) and GTR in (20%, 8/40) patients. Based on
craniopharyngioma clinical status scale, 40% (16/40) of patients have sever neurologic deficit,
iv
42.5% (17/40) of patients have bilateral blindness, 25% (10/40) have DI and panhypopituitarism,
45% (18/40) of patients have post operative obesity and 60% (24/40) of patients are entirely
dependent on others for self-care. The mortality rate was 47.5% (19/40). There was statistically
significant association between tumor epicenter, tumor size, brain stem involvement, HCP,
meningitis, dysnatremia, length of hospital stay and length of ICU stay with poor functional
outcome.
Conclusion: Craniopharyngioma is associated with very high rate of mortality rate in our setup
and higher grade of hypothalamic involvement and signs of increased ICP at presentation are
predictors of mortality. Majority of the survivors have also significant ophthalmologic,
neurologic and endocrinologic morbidities.
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Keywords
Craniopharyngioma, MEDICINE::Surgery