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Comparison between extended transsphenoidal and transcranial surgery for craniopharyngioma: focus on hypothalamic function and obesity

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Abstract

Purpose

Patients suffering from craniopharyngiomas currently have good survival rates, but long-term sequelae, such as development of obesity, worsen their quality of life. Optimal treatment is still controversial and changed during the decades, becoming less aggressive. Transcranial (TC) surgery was the first approach to be used, followed by extended transsphenoidal (eTNS) access. This study aims to compare the two approaches in terms of risk of hypothalamic damage leading to obesity.

Methods

This is a monocentric retrospective analysis of post-puberal patients treated for primary craniopharyngioma. Postoperative obesity and percentual postsurgical BMI variation were considered proxy for hypothalamic function and used to fit regression models with basal BMI, type of surgery, tumor volume and hypothalamic involvement (anterior vs. anteroposterior).

Results

No difference in radicality was observed between the two approaches; eTNS was more effective in ameliorating visual function but was significantly associated with CSF leaks. The TC approach was associated with a higher incidence of diabetes insipidus. Regression analysis showed only tumor volume and basal BMI resulted as independent predictors for both postoperative obesity (respectively, OR 1.15, P = 0.041, and OR 1.57, P < 0.001) and percentual BMI variation (respectively, + 0.92%, P = 0.005, and − 1.49%, P = 0.001).

Conclusions

Larger lesions portend a higher risk to develop postoperative obesity, independently of hypothalamic involvement. Interestingly, basal BMI is independent of lesional volume and is associated with postoperative obesity, but lesser postoperative BMI variation. The surgical approach does not influence the obesity risk. However, eTNS proves valid in managing large tumors with important hypothalamic invasion.

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Data availability

The datasets generated and analyzed during the current study are secured in the institution archive and are available from the corresponding author on reasonable request.

Code availability

The R code scripts used for the current study analyses are available from the corresponding author on reasonable request.

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Funding

No funds, grants, or other support was received.

Author information

Author notes

  1. Marco Losa and Pietro Mortini—co-last authorship.

Authors and Affiliations

  1. Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy

    Alberto Luigi Gallotti, Lina Raffaella Barzaghi, Luigi Albano, Marzia Medone, Filippo Gagliardi, Marco Losa & Pietro Mortini

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  1. Alberto Luigi Gallotti
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  2. Lina Raffaella Barzaghi
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  3. Luigi Albano
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  4. Marzia Medone
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  6. Marco Losa
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  7. Pietro Mortini
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Contributions

Conceptualization: ALG, LRB, ML; Methodology: ALG, LRB, ML; Formal analysis and investigation: ALG; Writing—original draft preparation: ALG; Writing—review and editing: ALG, LRB, ML, MM, LA, FG, PM; Supervision: PM.

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Correspondence to Alberto Luigi Gallotti.

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The authors have no conflicts of interest to declare that are relevant to the content of this article.

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Informed consent was obtained from all individual participants included in the study.

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This type of study does not require specific consent for data publication; however all participants signed a general consent to publish results obtained from studies involving their data.

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This is an observational study. The Vita-Salute University, I.R.C.C.S. San Raffaele Scientific Institute Research Ethics Committee has confirmed that no ethical approval is required.

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Cite this article

Gallotti, A.L., Barzaghi, L.R., Albano, L. et al. Comparison between extended transsphenoidal and transcranial surgery for craniopharyngioma: focus on hypothalamic function and obesity. Pituitary 25, 74–84 (2022). https://doi.org/10.1007/s11102-021-01171-2

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