Clinical Value of Optical Coherence Tomography in Craniopharyngioma

TL;DR

Optical coherence tomography (OCT) and OCT angiography (OCTA) help detect and monitor optic nerve damage in craniopharyngioma patients, improving visual outcome predictions.

Contribution

This review proposes OCT and OCTA as objective tools for assessing and predicting visual outcomes in craniopharyngioma.

Findings

OCT detects retinal nerve fiber layer and ganglion cell complex thinning linked to visual impairment.

OCTA identifies microvascular changes before structural damage occurs.

OCT metrics can predict postoperative visual recovery in craniopharyngioma patients.

Abstract

Craniopharyngioma is a rare benign brain tumor that often develops near the optic nerves and optic chiasm, which can lead to significant vision problems in both children and adults. Early detection of optic nerve damage is important to preserve visual function. Optical coherence tomography (OCT) and OCT angiography (OCTA) are noninvasive imaging techniques that allow detailed evaluation of the retina and its blood vessels. Changes such as thinning of the retinal nerve fiber layer and ganglion cell complex are associated with visual impairment and may help predict visual recovery after neurosurgery. OCTA can also detect microvascular alterations that may appear before structural damage. This review summarizes current knowledge about the role of OCT and OCTA in diagnosis, monitoring, and prognosis of visual outcomes in patients with craniopharyngioma.

Craniopharyngioma (CP) is a rare benign tumor of the sellar and suprasellar region that often compresses the optic pathways, causing significant visual impairment in both children and adults. The early detection and monitoring of optic nerve involvement are essential for preserving visual function. Optical coherence tomography (OCT) and OCT angiography (OCTA) are noninvasive, high-resolution imaging modalities that provide quantitative assessment of retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC), and retinal microvasculature. Thinning of the RNFL and GCC correlates with visual field defects and reduced visual acuity and may also serve as a predictor of postoperative visual recovery. OCTA reveals microvascular alterations that may precede structural damage and, together with other imaging parameters, can be used to estimate the likelihood of visual improvement after neurosurgery. This review summarizes current evidence on the use of OCT and OCTA in CP, highlighting their applications in assessment of optic pathway involvement, preoperative evaluation, postoperative monitoring, and risk stratification. Based on our clinical experience, we propose a table with recommended OCT parameters and follow-up intervals. Importantly, OCT should be interpreted alongside the visual acuity, visual field testing, and fundus examination for comprehensive assessment. Future directions include the standardization of imaging protocols and prospective multicenter studies, and integration of OCTA metrics into predictive models of visual outcomes. OCT and OCTA provide objective, reproducible biomarkers that support individualized patient care and may improve visual prognosis in CP.

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