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

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Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

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Abbreviations

BMI:

Body mass index

CT:

Computed tomography

DI:

Diabetes insipidus

FLAIR:

Fluid attenuated inversion recovery

GTR:

Gross total removal

MRI:

Magnetic resonance imaging

WI:

Weighted image

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Authors and Affiliations

  1. Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan

    Yasuhiko Hayashi, Yasuo Sasagawa, Masahiro Oishi, Kouichi Misaki & Mitsutoshi Nakada

  2. Department of Radiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan

    Kazuto Kozaka

  3. Department of Neurosurgery, Kanazawa Medical University, Kanazawa, Japan

    Osamu Tachibana

Authors
  1. Yasuhiko Hayashi
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  2. Yasuo Sasagawa
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  3. Masahiro Oishi
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  4. Kouichi Misaki
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  5. Kazuto Kozaka
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  6. Osamu Tachibana
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  7. Mitsutoshi Nakada
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Correspondence to Yasuhiko Hayashi.

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Hayashi, Y., Sasagawa, Y., Oishi, M. et al. Radiological and endocrinological evaluations with grading of hypothalamic perifocal edema caused by craniopharyngiomas. Pituitary 22, 146–155 (2019). https://doi.org/10.1007/s11102-019-00945-z

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