Predictors of Quality of Life in Craniopharyngioma after Endoscopic Endonasal Surgery

Abstract Craniopharyngioma are complex tumors that significantly affect quality of life (QoL). Understanding longitudinal changes and factors influencing QoL would guide surgical strategy and uncover therapeutic targets, ultimately improving patient outcome. A prospective cohort of consecutive craniopharyngioma (n = 30) operated through the endoscopic endonasal approach was analyzed. Overall (ABSQ-35) and sinonasal (SNOT-22) QoL was assessed longitudinally throughout the first postoperative year. Preoperative QoL correlated with the presence of visual failure (p = 0.01). Sinonasal QoL acutely worsened postoperatively but returned to baseline by 6 weeks after surgery. Overall QoL worsened after surgery, returning to preoperative baseline 12 months after surgery. Male sex (p = 0.03), hypothalamic involvement (p = 0.04), new hypopituitarism (p < 0.01), and longer tumor anteroposterior length (p = 0.03) predicted worsening QoL at 6 months, whereas visual field improvement (p = 0.03) and gross total resection (p = 0.04) were associated with QoL improvement. Sleep was the most troublesome symptom for 34.4% of patients at baseline and 42.1% at 6 months after surgery. Sleep dysfunction correlated with hypothalamic involvement (p < 0.01), new arginine vasopressin deficiency (p = 0.04), and preoperative visual field loss (p = 0.04) and hypopituitarism (p = 0.04). The change in overall QoL at 6 months was strongly correlated with the change in SNOT sleep domain scores at 6 months (r = −0.52, p = 0.02). Surgery is a major source of morbidity in patients with craniopharyngioma. Sinonasal morbidity is short-lived, whereas overall QoL does not often improve within the first postoperative year, particularly in patients with high-grade hypothalamic involvement, subtotal resection, or postoperative hypopituitarism. Sleep disorders contribute significantly to poor QoL and are a target for therapeutic interventions.