From the Guidelines
The initial visual symptoms of a craniopharyngioma typically include vision loss, particularly bitemporal hemianopsia, and decreased visual acuity, as reported in the most recent study 1. These visual disturbances occur because craniopharyngiomas often grow near the optic chiasm, where the optic nerves cross, causing compression of these structures.
- Patients may notice gradual deterioration in their ability to see objects in their peripheral visual fields,
- difficulty with depth perception, or
- blurry vision. Children might not recognize or report these changes, instead showing signs like
- bumping into objects,
- sitting closer to screens, or
- declining school performance. Visual symptoms are often the presenting complaint that leads to diagnosis, as they can occur before other symptoms like headaches, hormonal imbalances, or increased intracranial pressure become apparent. Early recognition of these visual changes is crucial for prompt diagnosis and treatment to prevent permanent vision loss, and monitoring should be determined on an individual patient basis, depending on baseline visual assessment and MRI appearance 1. It is also important to note that age < 6 years and the presence of visual symptoms at diagnosis indicate an increased risk of poor visual outcomes 1. In terms of diagnostic evaluation, MRI is considered the optimal first-line test, although CT may provide useful information in certain clinical settings, such as sudden onset of pituitary dysfunction 1.
From the Research
Initial Visual Symptoms of Craniopharyngioma
The initial visual symptoms of craniopharyngioma can vary, but some common symptoms include:
- Blurred vision, which was the most common visual complaint in 64% of patients 2
- Deficits in visual acuity, which occurred in 36% of patients 2
- Bitemporal hemianopia, which was present in 44% of patients on presentation 2
- Pleomorphism (change from one type of visual field defect to another), which occurred in 11 patients 2
- Acute peripheral visual field loss 3
- Acute blindness, which was reported in a case of an elderly man with craniopharyngioma 4
- Progressive loss of visual acuity, which was a typical initial eye symptom 5
Factors Influencing Visual Symptoms
The visual symptoms of craniopharyngioma can be influenced by several factors, including:
- Tumor localization and growth 6
- Patient's age, with adults more likely to present with visual symptoms than children 2, 6
- Vascular factor, mechanic influence of a volumic formation and brain base major vessels on the optic route structures, toxic effects, and the presence of an optic route nervous tissue edema 6
Importance of Early Detection
Early detection of craniopharyngioma is crucial to prevent long-term visual damage and other complications. Regular neuro-ophthalmic review is useful in the early detection of anterior visual pathway compression by recurrent tumor 2. Eye care professionals should be aware that craniopharyngiomas can present with decreased visual acuity and bitemporal hemianopia, and that visual deficits can arise from both the aggressive nature of craniopharyngiomas as well as the therapeutic intervention 3.