The present cohort included 37 (42.0%) male patients, and the mean age was 44.0 years old (range, 19-68 years). The most common preoperative symptom was visual impairment (78 patients; 88.6%) and the mean duration of such symptom was 6.2 months (range, 1-24 months). The median tumor volume was 6.5 cm3 (IQR, 3.4-14.0 cm3).The clinicoradiological data of 88 patients was showed in Table 1.
Preoperative Visual Function
One hundred and twenty-three eyes (72.4%) had VA impairment preoperatively. The median BCVA was 0.2 logMAR (IQR,0 to 0.5). VF defects occurred in one hundred and forty-nine eyes (87.6%). MD, PSD, VFI on VF testing was -9.3 (IQR, -14.8 to -4.9), 7.7 (IQR, 3.5 -11.4), 77.5 (IQR, 56.5-90), respectively. The mean global RNFL thickness was 97.05 ± 13.17 mm. It was 121.72 ± 19.36 mm in the inferior quadrant, 124.66 ± 20.24 mm in the superior quadrant, 70.53 ± 13.96 mm in the nasal quadrant, and 70.28 ± 12.42 mm in the temporal quadrant, respectively. Inner average, superior and inferior mGCC thickness was 91.68 ± 9.15 mm, 91.00 ± 9.34 mm and 92.36 ± 9.49 mm, respectively (Table 1).The associations between the mGCC parameters, cpRNFL thickness parameters and VF parameters in the 170 eyes were showed in Table 2. mGCC parameters significantly correlated with MD, PSD and VFI. All cpRNFL thickness parameters were significantly associated with MD except for the superior quadrant, PSD except for the nasal quadrant and VFI except for the inferior and nasal quadrant, respectively.
Overall Surgical Results
GTR was achieved in 82 (93.2%) patients. Of the six cases with residual tumors, three were observed without further treatment, and three received gamma knife radiosurgeries postoperatively without causing new visual defects. Tight adhesion was observed in 31(35.2%) patients. Adamantinomatous craniopharyngiomas were confirmed in 67 (76.1%) patients. After a median follow-up duration of 10.9 months, recurrence occurred in 2 (2.3%) patients. Of these patients, one did radiotherapy, and the other was observed without adjuvant therapy. There was no new visual impairment occurred in these two patients.
Postoperative Visual Outcome
The follow-up time was 10.9 (IQR, 7.2-16.2) months. Among 123 eyes with preoperative VA impairment, VA improved in 78.0% but worsened in 4.9% postoperatively. Five (10.6%) of the 47 eyes with normal preoperative VA had postoperative VA deterioration. Of the 149 eyes with preoperative VF impairment, 83 (55.7%) experienced improved or normalized VF, with no change in 58 (38.9%), and 8 (5.4%) experienced deterioration after surgery. Eighteen (85.7%) of 21 eyes with normal preoperative VF showed no change and 2 (9.5%) experienced worsening. The median BCVA after surgery was 0.1 logMAR (IQR, 0 to 0.2), which was significantly lower than the preoperative 0.2 logMAR (IQR, 0 to 0.5) (P <0.001). The MD (IQR) showed a significant improvement from -9.3 (IQR, -14.8 to -4.9) preoperatively to -5.3 (IQR, -9.9 to -2.5) postoperatively (P <0.001).
Prognostic Factors for Visual Prognosis
Univariate logistic regression analysis for visual improvement and maintenance by OCT parameters were summarized in Table 3, and increased temporal (P=0.001) and inferior cpRNFL thickness (P=0.004) proved to be independent prognostic factors. Clinicoradiological factors were also assessed, and the univariate analysis results revealed that tight adhesion and gender were associated significantly with postoperative visual outcome. In the multivariate analysis, increased temporal (OR,1.070; 95% confidence interval [CI], 1.005-1.140; P=0.035) and inferior cpRNFL thickness (OR,1.034; 95% CI,1.001-1.068; P=0.046) proved to be independent favorable factors for VA (Fig. 3A and 4 ) and VF (Fig. 3B and 5 ) improvement and maintenance after surgery, respectively. Moreover, tight adhesion was confirmed as an independent risk factor for VA (OR,0.188; 95% CI, 0.036-0.986; P=0.048) or VF (OR,0.162; 95% CI, 0.032-0.836; P=0.030) after surgery for craniopharyngiomas. Multivariable prediction models developed for postoperative VA and VF recovery and maintenance, including age, gender, cpRNFL thickness and adhesion strength, showed AUC of 0.842 (95% CI, 0.730-0.954; P <0.001) and 0.849 (95% CI, 0.741-0.958; P <0.001), respectively (Fig. 6).