The Role of Tumor-Associated Hypothalamic Involvement in Surgical Treatment and Long-Term Outcome in Adult Patients with Craniopharyngioma

Abstract

IntroductionHypothalamic invasion in pediatric patients with craniopharyngioma negatively influences clinical outcomes. It has been demonstrated that radiological classification of hypothalamic invasion can effectively predict surgical strategies to minimize postoperative comorbidities in pediatric patients 1. However, no comparative analysis has been performed in adult craniopharyngioma patients. This study implements the previously established radiological classification to characterize postoperative morbidity, surgical outcome, and distress in adult craniopharyngioma patients. MethodsElectronic medical records of 22 adult craniopharyngioma patients were used to analyze patient demographics, surgical data, endocrinological and ophthalmological status and histopathology in a retrospective, single center study. Questionnaires regarding postoperative distress (NCCN Distress Thermometer and Problem List), comorbidities (Charlston Comorbidity Index (CCI), employment status and need for supportive care were distributed. MRI scans were categorized according to Puget et al. ResultsPatients with hypothalamic involvement display significantly higher rates of postoperative Diabetes Inspidus and higher scores on the NCCN Distress. This significant difference was lost when considering postoperative Puget grades. Puget grades 1 and 2 were found to be associated with use of subfrontal surgical approach (HR 4.080 [CI 1.153-14.431]; p = 0.029). ConclusionOur results point towards a possible predictive role of preoperative hypothalamic invasion for postoperative diabetes insipidus as well as higher perceived levels of distress following surgery which may be established in larger patient cohorts. Furthermore, a subfrontal surgical approach appears to be predicted by tumors with hypothalamic invasion. In this case, preoperative MRI grading may help guide planning of an optimal surgical strategy for adults with craniopharyngioma to reduce postoperative morbidity.