Dramatic Course and Remarkable Improvement in Visual Function in a Child With Craniopharyngioma

Craniopharyngiomas are tumors with benign histology and malignant behavior. Here we describe a dramatic visual course secondary to craniopharyngioma.

Poster 203 Dramatic Course and Remarkable Improvement in Visual Function in a Child with Craniopharyngioma Etti Katzburg1, Einat Klein1, Anat Bachar Zipori1, Jonathan Roth1 1 Tel Aviv Medical Center, Tel Aviv, Israel Introduction: Craniopharyngiomas are tumors with benign histology and malignant behavior. Here we describe a dramatic visual course secondary to craniopharyngioma. Description of Case(s): An 11-year-old girl, presented to the ED with complaints of severe worsening headache in the last month. During her stay in the ED the patient entered an altered state of consciousness. An emergent CT scan demonstrated a giant suprasellar prepontine mass with obstructive hydrocephalus. MRI revealed a semi solid-semi cystic mass compressing the left optic tract and left optic chiasm. She underwent a partial resection of the tumor. Pathology confirmed an adamantinomatous craniopharyngioma. Once stabilized, ophthalmology evaluation revealed VA of 20/30 in BE, optic nerve function, and slitlamp examination were normal in BE. Visual fields reviled a pattern of left inferior quadrianopia. Those finding were stable pre-operatively and 3 weeks post-surgery. The patient was referred to proton-based RT in another medical center. One month after completing RT the patient came back to our clinic, complaining about progressive vision loss in her RE. On examination VA of the RE was NLP, and 20/30 in the LE. The right pupil was amaurotic. The visual field of the left eye showed complete temporal impairment. The right optic disk had sharp borders and was slightly pale while the left optic disc had a normal appearance. An MRI revealed a large frontal cyst compressing the right optic nerve and chiasm. The next morning the patient underwent trans-sphenoidal drainage of the cyst. 2 days post drainage her VA was improved to 6/12 on RE with only mild RAPD (+1). Visual fields improved dramatically as well. Conclusions, including unique features of the case(s): Craniopharyngioma is a rare tumor that can present with fulminant symptoms. Visual impairment due to direct pressure on optic structures is not uncommon. Awareness and early intervention are required and can restore vision even in cases of severe visual loss. References: None. Keywords: tumors Financial Disclosures: The authors had no disclosures. Grant Support: None. Contact Information: None provided. 2022 Annual Meeting Syllabus | 265