A case study of the neuropsychological outcomes following microsurgery, conventional radiotherapy and stereotactic radiotherapy for an adult’s recurrent craniopharyngioma

Abstract

Objective: To examine the neuropsychological outcomes for an adult patient, 2 years after receiving microsurgery and conventional radiotherapy for a recurrent craniopharyngioma; and the impact of a further intervention, stereotactic radiotherapy, on this level of neuropsychological functioning.

Participant: JD, a 30 year old male whose recurrent craniopharyngioma had 2 years earlier been treated with two operations and conventional radiotherapy.

Design: JD was assessed (using standardized clinical tests) before and after a course of stereotactic radiotherapy.

Results: Prior to stereotactic radiotherapy (and 2 years after microsurgery and conventional radiotherapy) JD’s IQ was intact, but considerable impairments were present in executive functioning, memory, theory of mind and processing speed. Fifteen months after stereotactic radiotherapy, all neuropsychological domains remained largely static or improved, supporting the utility of this treatment option in the neuropsychological domain. However, deficits in executive functioning, memory and processing speed remained.

Conclusion: These findings suggest that, even after multiple treatments, substantial cognitive impairments can be present in an adult patient with a recurrent craniopharyngioma. This profile of deficits underlines the inadequacy of relying purely on IQ as a marker for cognitive health in this population and emphasizes the need to include neuropsychological impairments as a focus of rehabilitation with these patients.

• Executive functioning
• intelligence
• memory
• neuropsychological
• outcome
• surgery

Acknowledgements

The authors would like to thank JD and his family for their time and effort. We also gratefully acknowledge Dr. Frans Hugo, Dr. Sharon Truter and Mr. Peter Clissa for their valuable feedback on earlier drafts of this paper. Ethics approval for this project was granted by the Edith Cowan University Human Research Ethics Committee. The requirements of this committee were adhered to.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.