Abstract
Background and purpose
Obesity is a major concern in children treated for craniopharyngioma and is caused by hypothalamic damage. The role of aggressive surgical removal has been questioned, leading some authors to recommend a minimalist approach. In order to test this hypothesis, we decided to study obesity in craniopharyngioma and the factors related to it.
Materials and methods
We reviewed retrospectively our series of pediatric craniopharyngiomas operated since 1981. The body-mass index (BMI) was calculated for each patient pre- and at several intervals postoperatively and expressed as standard deviations (SD) adjusted for age and gender.
Results
We operated on 45 cases, which were followed up for a mean duration of 11.0 years. Initial resection was total in 25 cases (55.6%). No patient died because of surgery or tumor progression; two died with delay presumably because of endocrine failure. At last control, 28 patients (62%) had obesity (BMI over +2SD). Hypothalamic involvement was significantly correlated with preoperative and postoperative BMI. Subtotal tumor resection was significantly associated with obesity at last control. Reoperation for tumor recurrence was associated with a significantly higher BMI.
Conclusions
Our results suggest that obesity results from hypothalamic lesions caused by the tumor rather than by surgery. The postoperative weight gain appears to result from the continued impact of preoperative hypothalamic damage. The high rate of tumor recurrence in children, with the risk of additional damage to the hypothalamus, incites us to recommend total resection whenever it appears safe during initial surgery.
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References
Caldarelli M, di Rocco E, Papacci F, Colosimo C (1998) Management of recurrent craniopharyngioma. Acta Neurochir 140:447–454
De Vile C, Grant DB, Kendall BE, Neville BGR, Stanhope R, Watkins KE, Hayward R (1996) Management of childhood craniopharyngioma: can the morbidity of radical surgery be predicted? J Neurosurg 83:73–81
Dhellemmes P, Vinchon M (2006) Radical resection for craniopharyngiomas in children: surgical technique and clinical results. J Pediatr Endocrinol Metab 19(Suppl 1):329–335
Duff JM, Meyer FB, Ilstrup DM, Laws ER, Schleck CD, Scheitauer BW (2000) Long-term outcomes for surgically resected craniopharyngiomas. Neurosurgery 46:291–305
Hayward RD, de Vile C, Brada M (2004) Craniopharyngioma. In: Walker DA, Perilongo G, Punt JAG, Taylor RE (eds) Brain and spinal tumors of childhood. London, Arnold, pp 370–386
Hoffman HJ, Kestle JR (1994) Craniopharyngiomas. In: Cheek WR, Marlin AE, McLone DG, Reigel DH, Walker ML (eds) Pediatric neurosurgery. 3rd edn. Philadelphia, Saunders, pp 418–428
Lefranc F, Chevalier C, Vinchon M et al (2003) Characterization of the level of expression of retinoic acid receptors, galectin-3, macrophage migration inhibiting factor, and p53 in 51 adamantinomatous craniopharyngiomas. J Neurosurg 98:145–153
Lunsford LD, Pollock BE, Kondziolka DS, Levine G, Flickinger JC (1994) Stereotactic options in the management of craniopharyngioma. Pediatr Neurosurg 21(suppl 1):90–97
Müller HL, Emser A, Faldum A, Bruhnken G, Etavard-Gorris N, Gebhardt U, Oeverink R, Kolb R, Sörensen N (2004) Longitudinal study on growth and body mass index before and after diagnosis of childhood craniopharyngioma. J Clin Endocrinol Metab 89:3298–3305
Müller HL, Müller-Stöver S, Gebhardt U, Kolb R, Sörensen N, Handwerker G (2006) Secondary narcolepsy may be a causative factor of increased daytime sleepiness in obese childhood craniopharyngioma patients. J Pediatr Endocrinol Metabol 19:423–429
Puget S, Garnett M, Wray A et al (2007) Pediatric craniopharyngiomas: classification and treatment according to the degree of hypothalamic involvement. J Neurosurg (Pediatrics) 106:3–12
Regine WF, Kramer S (1992) Pediatric craniopharyngiomas: long-term results of combined treatment with surgery and radiation. Int J radiation Oncology Biol Phys 24:611–617
Rekate Harold L (2005) Craniopharyngioma (editorial). J Neurosurg (Pediatr suppl) 103(suppl 4):297–298
Rolland-Cachera MF, Cole TJ, Sempé M, Tichet J, Rossignol C, Charraud A (1991) Body mass index variations: centiles from birth to 87 years. Eur J Clin Nutr 45:13–21
Roth C, Wilken B, Hanefeld F, Schroter W, Leonhardt U (1998) Hyperphagia in children with craniopharyngioma is associated with hyperleptinaemia and a failure in the downregulation of appetite. Eur J Endocrinol 138:89–91
Sainte-Rose C, Puget S, Wray A et al (2005) Craniopharyngioma: the pendulum of surgical management. Childs Nerv Syst 21:691–695
Sands SA, Milner JS, Goldberg J, Mukhi V, Moliterno JA, Maxfield C, Wisoff JH (2005) Quality of life and behavioral follow-up study of pediatric survivors of craniopharyngioma. J Neurosurg (Pediatr suppl) 103(suppl 4):302–311
Scarzello G, Buzzaccarini MS, Perilongo G et al (2006) Acute and late morbidity after limited resection and focal radiation therapy in craniopharyngioma. J Pediatr Endocrinol Metabol 19:399–405
Sklar CA (1994) Craniopharyngioma: endocrine sequelae of treatment. Pediatr Neurosurg 21(suppl 1):120–123
Stripp DC, Maity A, Janss AJ et al (2004) Surgery with or without radiation therapy in the management of craniopharyngiomas in children and young adults. Int J Radiat Oncol Biol Phys 58:714–720
Thompson D, Phipps K, Hayward R (2005) Craniopharyngioma in childhood: our evidence-based approach to management. Childs Nerv Syst 21:660–668
Till K (1982) Craniopharyngioma. Childs Brain 9:179–187
Van Effenterre R, Bloch AL (2002) Craniopharyngiomas in adults and children: a study of 122 cases. J Neurosurg 97:3–11
Villani RM, Tomei G, Bello L et al (1997) Long-term results of treatment for craniopharyngioma in children. Childs Nerv Syst 13:397–405
Vinchon M, Dhellemmes P (2008) Craniopharyngioma in children: recurrence, reoperation, and outcome. Childs Nerv Syst 24:211–217
Weiner HL, Wisoff JH, Rosenberg ME et al (1994) Craniopharyngiomas: a clinicopathological analysis of factors predictive of recurrence and functional outcome. Neurosurgery 39:1070–1071
Yasargil GM, 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, 73:3–11
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Vinchon, M., Weill, J., Delestret, I. et al. Craniopharyngioma and hypothalamic obesity in children. Childs Nerv Syst 25, 347–352 (2009). https://doi.org/10.1007/s00381-008-0754-x
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DOI: https://doi.org/10.1007/s00381-008-0754-x