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 andtreatment outcomes of patients with craniopharyngioma are from westerns and the long termneurological, endocrinological, ophthalmological and psychosocial outcomes are not wellstudied 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 MCMcomprehensive 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 inAddis Ababa, Ethiopia which are affiliated Neurosurgical hospitals. The long term neurological,ophthalmological, endocrinologic and general functional outcomes of patients treated for the past10 years from Jan 2013 to Jan 2023 was studied. Data was collected by chart review and viaphone contact to the patients. The MRI/CT image was re-evaluated when available. Theneurological, ophthalmological, endocrinological and overall functional outcomes wereanalyzed. The functional independence and Craniopharyngioma clinical status scale (CCSS) wasused to assess the overall functional status of patients. Factors affecting the functional outcomewere 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 andcortisol 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 oncraniopharyngioma clinical status scale, 40% (16/40) of patients have sever neurologic deficit,iv42.5% (17/40) of patients have bilateral blindness, 25% (10/40) have DI and panhy popituitarism,45% (18/40) of patients have post operative obesity and 60% (24/40) of patients are entirelydependent on others for self-care. The mortality rate was 47.5% (19/40). There was statisticallysignificant association between tumor epicenter, tumor size, brain stem involvement, HCP,meningitis, dysnatremia, length of hospital stay and length of ICU stay with poor functionaloutcome.
Conclusion: Craniopharyngioma is associated with very high rate of mortality rate in our setupand higher grade of hypothalamic involvement and signs of increased ICP at presentation arepredictors of mortality. Majority of the survivors have also significant ophthalmologic,neurologic and endocrinologic morbidities.
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Keywords
Craniopharyngioma, MEDICINE::Surgery