, Volume 22, Issue 2, pp 146–155 | Cite as

Radiological and endocrinological evaluations with grading of hypothalamic perifocal edema caused by craniopharyngiomas

  • Yasuhiko HayashiEmail author
  • Yasuo Sasagawa
  • Masahiro Oishi
  • Kouichi Misaki
  • Kazuto Kozaka
  • Osamu Tachibana
  • Mitsutoshi Nakada



Hypophysial and hypothalamic dysfunction caused by craniopharyngioma is a serious problem despite the progress of surgical approaches and techniques. Perifocal edema induced by craniopharyngioma could be speculated as a potential factor resulting in pre- and post-operative hypophysial and hypothalamic dysfunction, as well as, their anatomical involvement.


Medical records of 54 patients with craniopharyngioma were retrospectively reviewed. The edema was characterized by a hyperintense area in magnetic resonance imaging, being classified into no edema (group A), only adjacent to the tumor (group B), and extending to the internal capsule or the optic tract (group C). Age, sex, tumor diameter, presence of cyst, hydrocephalus, intracranial pressure (ICP) elevation, visual function impairment, hypopituitarism, diabetes insipidus, memory disturbance, and obesity were investigated.


The occurrence rate of edema was found more frequently in adults (73.7%) than in children (25.0%). The peritumoral edema grading system had an excellent correlation with the degree of hypothalamic involvement graded by the Puget’s system. Pre-operative ICP elevation was significantly detected in group C when compared with the other groups. In adults patients, group C was significantly associated with the occurrence of hydrocephalus both in pre- and post-operatively. Pre- and post-operative hypothalamic dysfunction, including diabetes insipidus, memory disturbance, and obesity, were highest in group C.


Hypothalamic dysfunctions greatly influence the quality of daily living following craniopharyngioma surgery. The grading of perifocal edema’s extension could be a new index suggesting pre- and post-operative hypothalamic dysfunction caused by craniopharyngioma in addition to their anatomical involvement.


Craniopharyngioma Edema Hypothalamus Magnetic resonance imaging Hyperintensity 



Body mass index


Computed tomography


Diabetes insipidus


Fluid attenuated inversion recovery


Gross total removal


Magnetic resonance imaging


Weighted image


Compliance with ethical standards

Conflict of interest

There is no conflict of interest in this study.


  1. 1.
    Lanksch WR (1982) The diagnosis of brain edema by computed tomogramphy. In: Hartmann A, Brock M (eds) Treatment of cerebral edema. Springer, Berlin, pp 43–80CrossRefGoogle Scholar
  2. 2.
    Higashi S, Yamashita J, Fujisawa H, Yamamoto Y, Kadoya M (1990) “Moustache” appearance in craniopharyngiomas: unique magnetic resonance imaging and computed tomogramphic findings of perifocal edema. Neurosurgery 27:993–996CrossRefGoogle Scholar
  3. 3.
    Nagahata M, Hosoya T, Kayama T, Yamaguchi K (1998) Edema along the optic tract: useful MR finding for the diagnosis of craniopharyngiomas. AJNR Am J Neuroradiol 19:1753–1757Google Scholar
  4. 4.
    Saeki N, Uchino Y, Murai H, Kubota M, Isobe K, Uno T, Sunami K, Yamaura A (2003) MR imaging study of edema-like change along the optic tract in patients with pituitary region tumor. AJNR Am J Neuroradiol 24:336–342Google Scholar
  5. 5.
    Youl BD, Plant GT, Stevens JM, Kendall BE, Symon L, Crockard HA (1990) Three cases of craniopharyngioma showing optic tract hypersignal on MRI. Neurology 40:1416–1419CrossRefGoogle Scholar
  6. 6.
    Saeki N, Murai H, Kubota M, Fujimoto N (2001) Oedema along the optic tract due to pituitary metastasis. Br J Neurosurg 15:523–526CrossRefGoogle Scholar
  7. 7.
    Sklar EM, Schaz NJ, Glaser JS, Sternau I, Seffo F (2000) Optic tract edema in a meningioma of the tuberculum sellae. AJNR Am J Neuroradiol 21:1661–1663Google Scholar
  8. 8.
    Adachi M, Hosoya T, Haku T, Yamaguchi K (1998) Dilated Virchow-Robin spaces: MRI pathological study. Neuroradiology 40:27–30CrossRefGoogle Scholar
  9. 9.
    Bradbury MW, Cserr HF, Westrop RJ (1981) Drainage of cerebral interstitial fluid into deep cervical lymph of the rabbit. Am J Physiol 240:F329–F336Google Scholar
  10. 10.
    Hoffman HJ, De Silva M, Humphereys RP, Drake JM, Smith ML, Blaser SI (1992) Aggressive surgical management of craniopahryngioma in children. J Neurosurg 76:47–52CrossRefGoogle Scholar
  11. 11.
    Lapras C, Patet JD, Mottolese C, Charbi S, Lapras C Jr (1987) Craniopharyngiomas in childhood: analysis of 42 cases. Prog Exp Tumor Res 30:350–358CrossRefGoogle Scholar
  12. 12.
    Yasargil MG, Curcic M, Kis M, Siegenthaler G, Teddy PJ, Roth P (1990) Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients. J Neurosurg 73:3–11CrossRefGoogle Scholar
  13. 13.
    Carpentieri SC, Waber DP, Scott RM, Goumnrova LC, Kieran MW, Cohen LE, Kim F, Billett AL, Tarbell NJ, Pomeroy SL (2001) Memory deficits among children with craniopharyngiomas. Neurosurgery 49:1053–1058Google Scholar
  14. 14.
    Hayward R (1999) The present and future management of childhood craniopharyngioma. Childs Nerv Syst 15:764–769CrossRefGoogle Scholar
  15. 15.
    Puget S, Garnett M, Wray A, Grill J, Habrand JL, Bodaert N, Zerah M, Bezerra M, Renier D, Pierrr-Karn A, Sainte-Rose C (2007) Pediatric craniopharyngiomas: classification and treatment according to the degree of hypothalamic involvement. J Neurosurg 106(I Suppl Pediatrics):3–12Google Scholar
  16. 16.
    Van Effenterre R, Boch AL (2002) Craniopharyngiomas inadults and children; a study of 122 surgical cases. J Neurosurg 97:3–11CrossRefGoogle Scholar
  17. 17.
    Mortini P, Ganliardi F, Balio M, Spina A, Parlangeli A, Falini A, Losa M (2016) Magnetic resonance imaging as predictor of functional outcome in craniopharyngiomas. Endocrine 51:148–162CrossRefGoogle Scholar
  18. 18.
    Van Gompel JJ, Nippoldt TB, Higgins DM, Meyer FB (2007) Magnetic resonance imaging-guided hypothalamic compression in surgically treated adult craniopharyngiomas determining obesity. Neurosurg Focus 28:E3CrossRefGoogle Scholar
  19. 19.
    Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, Ohgaki H, Wiestler OD, Kleihues P, Ellison DW (2016) The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol 131:803–820CrossRefGoogle Scholar
  20. 20.
    Dastoli PA, Nicácio JM, Silva NS, Capellano AM, Toledo SR, Ierardi D, Cavalheiro S (2011) Cystic craniopharyngioma: intratumoral chemotherapy with alpha interferon. Arq Neuropsiquiatr 69:50–55CrossRefGoogle Scholar
  21. 21.
    Hensen J, Henig A, Fuhlbusch R, Meyer M, Boehnert M, Buchfelder M (1999) Prevalence, predictors and patterns of postoperative polyuria and hyponatremia in the immediate course after transsphenoidal surgery for pituitary adenomas. Clin Endocrinol 50:431–439CrossRefGoogle Scholar
  22. 22.
    Fischer EG, Welch K, Shillito J Jr, Winston KR, Tarbell NJ (1990) Craniopharyngiomas in children. Long-term effects of conservative surgical procedures combined with radiation therapy. J Neurosurg 73:534–540CrossRefGoogle Scholar
  23. 23.
    Mortini P, Ganliardi F, Boari N, Roberti F, Caputy AJ (2013) Surgical strategies and modern therapeutic options in the treatment of craniopharyngiomas. Crit Rev Oncol Hematol 88:514–529CrossRefGoogle Scholar
  24. 24.
    Merchant TE, Kiehna EN, Sanford RA, Mulhern RK, Thompson SJ, Wilson NW, Lusting RH, Kim LE (2002) Craniopharyngioma: the St. Jude Children’s Research Hospital experience 1984-2001. Int J Radiat Oncol Biol Phys 53:533–542CrossRefGoogle Scholar
  25. 25.
    Poretti A, Grotzer MA, Ribi K, Schonle E, Boltshauser E (2004) Outcome of craniopharyngioma in children: long-term complications and quality of life. Dev Med Child Neurol 46:220–229CrossRefGoogle Scholar
  26. 26.
    Svein HJ (1965) Surgical experiences with craniopharyngiomas. J Neurosurg 23:148–155CrossRefGoogle Scholar
  27. 27.
    Stevens JM, Ruiz JS, Kendall BE (1983) Observations on peritumoral oedema in meningioma. Part II; mechanisms of oedema production. Neuroradiology 25:125–131CrossRefGoogle Scholar
  28. 28.
    Hayashi Y, Kita D, Fukui I, Sasagawa Y, Oishi M, Okajima M, Tachibana O, Nakada M (2016) Pediatric symptomatic Rathke cleft cyst compared with cystic craniopharyngioma. Childs Nerv Syst 32:1625–1632CrossRefGoogle Scholar
  29. 29.
    Taylor M, Couto-Silva AC, Adan L, Trivin C, Sainte-Rose C, Zerah M, Valteau-Couanet D, Doz F, Chalumeau M, Brauner R (2012) Hypothalamic-pituitary lesions in pediatric patients: endocrine symptoms often precede neuro-ophthalmic presenting symptoms. J Pediatr 161:855–863CrossRefGoogle Scholar
  30. 30.
    Tan H, Yang W, Wu C, Liu B, Lu H, Wang H, Yan H (2017) Assessment of the role of intracranial hypertension and stress on hippocampal cell apoptosis and hypothalamic-pituitary dysfunction after TBI. Sci Rep 19:3805CrossRefGoogle Scholar
  31. 31.
    Herman JP, Seroogy K (2006) Hypothalamic-pituitary-adrenal axis, glucocorticoids, and neurologic disease. Neurol Clin 24:461–481CrossRefGoogle Scholar
  32. 32.
    Chen X, Zhao Z, Chai Y, Luo L, Jiang R, Dong J, Zhang J (2013) Stress-dose hydrocortisone reduces critical illness-related corticosteroid insufficiency associated with severe traumatic brain injury in rats. Crit Care 17:R241CrossRefGoogle Scholar
  33. 33.
    Chen X, Zhao Z, Chai Y, Luo L, Jiang R, Zhang J (2014) The incidence of critical-illness-related-corticosteroid-insufficiency is associated with severity of traumatic brain injury in adult rats. J Neurol Sci 15:93–100CrossRefGoogle Scholar
  34. 34.
    Prieto R, Pascual JM, Rosdolsky M, Castro-Dufourny I, Carrasco R, Strauss S, Barrios L (2016) Craniopharyngioma adherence: a comprehensive topographical categorization and outcome-related risk stratification model based on the methodical examination of 500 tumors. Neurosurg. Focus 41:E13CrossRefGoogle Scholar
  35. 35.
    Hussy N, Deleuze C, Desarménien MG, Moos FC (2000) Osmotic regulation of neuronal activity: a new role for taurine and glial cells in a hypothalamic neuroendocrine structure. Prog Neurobiol 62:113–134CrossRefGoogle Scholar
  36. 36.
    Shi XE, Wu B, Zhou ZQ, Fan T, Zhang YL (2006) Microsurgical treatment of craniopharyngiomas: report of 284 patients. Chin Med J (Engl) 119:1653–1663CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurosurgery, Graduate School of Medical ScienceKanazawa UniversityKanazawaJapan
  2. 2.Department of Radiology, Graduate School of Medical ScienceKanazawa UniversityKanazawaJapan
  3. 3.Department of NeurosurgeryKanazawa Medical UniversityKanazawaJapan

Personalised recommendations