Low concordance between surgical and radiological assessment of degree of resection and treatment-related hypothalamic damage: results of KRANIOPHARYNGEOM 2007
- 94 Downloads
Assessment of presurgical hypothalamic involvement (psHI) and treatment-related hypothalamic damage (trHD) is relevant for the decision on risk-adapted treatment and rehabilitation strategies in craniopharyngioma.
Patients and methods
129 surgical reports of childhood-onset craniopharyngioma patients recruited 2007–2014 in KRANIOPHARYNGEOM 2007 were analyzed. Data on psHI were available based on surgeon’s (63%), reference neuroradiologist’s (95%), and local radiologist’s (23%) assessment. The surgical degree of resection (DoR) was assessed by neurosurgeon (95%), reference neuroradiologist (73%), and local radiologist (61%). TrHD was assessed by neurosurgeon (33%), by reference neuroradiologist (95%), and by local radiologist (2%). Neurosurgical center size was categorized based on patient load.
Surgical assessments on psHI (n = 78), DoR (n = 89) and trHD (n = 42) as documented in surgical reports could be compared with the assessment of respective parameters by reference neuroradiologist. Differences with regard to DoR (p = 0.0001) and trHD (p < 0.0001) were detectable between surgeon’s and reference neuroradiologist’s assessment, whereas psHI was assessed similarly. Concordance for DoR and trHD was observed in 48 and 62%, respectively. Surgeons estimated a higher rate of complete resections and a lower rate of trHD. Neuroradiological reference assessment of trHD had higher predictive value for hypothalamic sequelae then surgical assessment. Observed differences were not related to neurosurgical center size.
Observed differences between surgical and neuroradiological estimation of risk factors in craniopharyngioma support the necessity of neuroradiological reference review to assure standards of quality. This could be established by central internet-based neuroradiological review in KRANIOPHARYNGEOM 2007. Standardization of surgical reports including specific assessment of tumor/damage location is recommended.
KeywordsCraniopharyngioma Neurosurgery Hypothalamus Obesity Quality of life Pediatrics
H. L. Müller is supported by the German Childhood Cancer Foundation, Bonn, Germany (DKS 2014.13).
Compliance with ethical standards
Conflict of interest
This manuscript was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
- 4.Muller HL, Gebhardt U, Teske C, Faldum A, Zwiener I, Warmuth-Metz M, Pietsch T, Pohl F, Sorensen N, Calaminus G (2011) Post-operative hypothalamic lesions and obesity in childhood craniopharyngioma: results of the multinational prospective trial KRANIOPHARYNGEOM 2000 after 3-year follow-up. Eur J Endocrinol 165(1):17–24. https://doi.org/10.1530/EJE-11-0158 CrossRefPubMedGoogle Scholar
- 5.Muller HL, Gebhardt U, Faldum A, Warmuth-Metz M, Pietsch T, Pohl F, Calaminus G, Sorensen N (2012) Xanthogranuloma, Rathke’s cyst, and childhood craniopharyngioma: results of prospective multinational studies of children and adolescents with rare sellar malformations. J Clin Endocrinol Metab 97(11):3935–3943. https://doi.org/10.1210/jc.2012-2069 CrossRefPubMedGoogle Scholar
- 7.Muller HL, Gebhardt U, Etavard-Gorris N, Korenke E, Warmuth-Metz M, Kolb R, Sorensen N, Calaminus G (2004) Prognosis and sequela in patients with childhood craniopharyngioma—results of HIT-ENDO and update on KRANIOPHARYNGEOM 2000. Klin Padiatr 216(6):343–348. https://doi.org/10.1055/s-2004-832339 CrossRefPubMedGoogle Scholar
- 8.Muller HL, Bueb K, Bartels U, Roth C, Harz K, Graf N, Korinthenberg R, Bettendorf M, Kuhl J, Gutjahr P, Sorensen N, Calaminus G (2001) Obesity after childhood craniopharyngioma–German multicenter study on pre-operative risk factors and quality of life. Klin Padiatr 213(4):244–249. https://doi.org/10.1055/s-2001-16855 CrossRefPubMedGoogle Scholar
- 11.Tallen G, Resch A, Calaminus G, Wiener A, Leiss U, Pletschko T, Friedrich C, Langer T, Grabow D, Driever PH, Kortmann RD, Timmermann B, Pietsch T, Warmuth-Metz M, Bison B, Thomale UW, Krauss J, Mynarek M, von Hoff K, Ottensmeier H, Fruhwald M, Kramm CM, Temming P, Muller HL, Witt O, Kordes U, Fleischhack G, Gnekow A, Rutkowski S (2015) Strategies to improve the quality of survival for childhood brain tumour survivors. Eur J Paediatr Neurol 19(6):619–639. https://doi.org/10.1016/j.ejpn.2015.07.011 CrossRefPubMedGoogle Scholar
- 16.Muller HL, Emser A, Faldum A, Bruhnken G, Etavard-Gorris N, Gebhardt U, Oeverink R, Kolb R, Sorensen N (2004) Longitudinal study on growth and body mass index before and after diagnosis of childhood craniopharyngioma. J Clin Endocrinol Metab 89(7):3298–3305. https://doi.org/10.1210/jc.2003-031751 CrossRefPubMedGoogle Scholar
- 17.Mortini P, Losa M, Pozzobon G, Barzaghi R, Riva M, Acerno S, Angius D, Weber G, Chiumello G, Giovanelli M (2011) Neurosurgical treatment of craniopharyngioma in adults and children: early and long-term results in a large case series. J Neurosurg 114(5):1350–1359. https://doi.org/10.3171/2010.11.JNS10670 CrossRefPubMedGoogle Scholar
- 20.Elowe-Gruau E, Beltrand J, Brauner R, Pinto G, Samara-Boustani D, Thalassinos C, Busiah K, Laborde K, Boddaert N, Zerah M, Alapetite C, Grill J, Touraine P, Sainte-Rose C, Polak M, Puget S (2013) Childhood craniopharyngioma: hypothalamus-sparing surgery decreases the risk of obesity. J Clin Endocrinol Metab 98(6):2376–2382. https://doi.org/10.1210/jc.2012-3928 CrossRefPubMedGoogle Scholar
- 22.Puget S, Grill J, Habrand JL, Sainte-Rose C (2006) Multimodal treatment of craniopharyngioma: defining a risk-adapted strategy. J Pediatr Endocrinol Metabol 19(Suppl 1):367–370Google Scholar
- 27.Barker FG 2nd, Klibanski A, Swearingen B (2003) Transsphenoidal surgery for pituitary tumors in the United States, 1996–2000: mortality, morbidity, and the effects of hospital and surgeon volume. J Clin Endocrinol Metab 88(10):4709–4719. https://doi.org/10.1210/jc.2003-030461 CrossRefPubMedGoogle Scholar
- 31.Faustini-Fustini M, Pasquini E, Zoli M, Mazzatenta D, Frank G (2013) Pituitary centers of excellence. Neurosurgery 73(3):E557. https://doi.org/10.1227/01.neu.0000431481.25279.37 CrossRefPubMedGoogle Scholar
- 32.Mercado M, Gonzalez B, Vargas G, Ramirez C, de los Monteros AL, Sosa E, Jervis P, Roldan P, Mendoza V, Lopez-Felix B, Guinto G (2014) Successful mortality reduction and control of comorbidities in patients with acromegaly followed at a highly specialized multidisciplinary clinic. J Clin Endocrinol Metab 99(12):4438–4446. https://doi.org/10.1210/jc.2014-2670 CrossRefPubMedGoogle Scholar
- 33.Casanueva FF, Barkan AL, Buchfelder M, Klibanski A, Laws ER, Loeffler JS, Melmed S, Mortini P, Wass J, Giustina A (2017) Criteria for the definition of Pituitary Tumor Centers of Excellence (PTCOE): a pituitary society statement. Pituitary 20(5):489–498. https://doi.org/10.1007/s11102-017-0838-2 CrossRefPubMedPubMedCentralGoogle Scholar