Abstract
Severe obesity is a major problem in pediatric craniopharyngioma. We investigated whether tumor origin, growth pattern, and surgical damage predict obesity in pediatric craniopharyngioma. Subjects were 58 patients (30 males) with no tumor recurrence during the first postoperative 18 months. Preoperative hypothalamic involvement was classified into no (pre_G0, n = 19), little (pre_G1, n = 21), and severe (pre_G2, n = 18) involvement groups based on sub- or supradiaphragmatic tumor origin and growth patterns. Postoperative hypothalamic involvement was classified into no (post_G0, n = 4), minimal (post_G1, n = 19), and significant (post_G2, n = 35) involvement groups according to follow-up imaging. The prevalence of obesity increased from 13.2 % at diagnosis (mean age = 8.1 years) to 37.9 % at last follow-up (mean duration = 9.1 years). Only the body mass index (BMI) Z-score increment of the first postoperative year (first-year ΔBMI_Z) was significant (P = 0.007). Both the preoperative BMI_Z (P = 0.001) and the first-year ΔBMI_Z (P = 0.017) showed an increasing trend from the pre_G0 to pre_G1 to pre_G2 group. For the 40 patients with pre_G0 or pre_G1, the first-year ΔBMI_Z was higher in the post_G2 group than the post_G1 group (0.02 ± 0.91 vs. 0.89 ± 0.72, P = 0.003). Tumor origin and growth pattern affect preoperative BMI_Z and postoperative weight gain. Despite little or no hypothalamic involvement at diagnosis, surgical damage contributes to postoperative weight gain in patients with craniopharyngioma.
Highlights
Childhood craniopharyngiomas are sellar and/or parasellar tumors originating from the remnants of Rathke’s pouch
We investigated whether tumor origin, growth pattern, and surgical damage predict obesity in pediatric craniopharyngioma
We investigated changes in the anthropometric characteristics during 4 years of follow-up and considered whether preoperative hypothalamic involvement and surgical damage were predictive of postoperative changes in body mass index Z-scores (BMI_Z) during the critical period of rapid weight gain
Summary
Childhood craniopharyngiomas are sellar and/or parasellar tumors originating from the remnants of Rathke’s pouch. Histologically benign, they are clinically malignant because of their anatomical proximity to the optic nerves, pituitary gland, and hypothalamus, and may cause visual impairment, endocrine deficiencies, and obesity after tumor resection surgery [1]. Obesity rates in children with craniopharyngiomas vary from 6 to 30 % at diagnosis and increase to 40–60 % after surgery [1, 3, 5, 6]. A major possible cause of obesity in these children is the disruption of hypothalamic mechanisms that control satiety, hunger, and energy balance [8].
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