Journal Article

Hypothalamic injury patterns after resection of craniopharyngiomas and correlation to tumor origin: A study based on endoscopic observation

Xie, ShenHao, Wu, Xiao, Bao, YouYuan, Hong, Tao, Yang, Le, Fang, Chao, Tong, ZhiGao, Ding, Han, Tang, Bin, Zheng, SuYue

2020

Overview

The precise understanding of hypothalamic injury (HI) patterns and their relationship with different craniopharyngioma (CP) classifications remains poorly addressed. Here, four HI patterns after CP resection based on endoscopic observation were introduced. A total of 131 CP cases treated with endoscopic endonasal approach (EEA) were reviewed retrospectively and divided into four HI patterns: no‐HI, mild‐HI, unilateral‐HI and bilateral‐HI, according to intraoperative findings. The outcomes were evaluated and compared between groups in terms of weight gain, endocrine status, electrolyte disturbance and neuropsychological function before and after surgery. A systematic correlation was found between CP origin and subsequent HI patterns. The majority of intrasellar and suprasellar stalk origins lead to a no‐HI pattern, the central‐type CP mainly develops a mild or bilateral HI pattern, and the majority of tumors with hypothalamic stalk origins result in unilateral HI and sometimes bilateral HI patterns. The proportion of tumors with a maximum diameter >3 cm in the no‐HI group was higher than that in the mild‐HI group, BMI and quality of life in the no‐HI group showed better results than those in the other groups. The incidence of new‐onset diabetes insipidus in the bilateral‐HI group was significantly higher than that in the other groups. Memory difficulty was observed mainly in the unilateral‐HI and bilateral‐HI groups. However, the outcomes of electrolyte disturbance, sleep, and cognitive disorder in the unilateral‐HI group were significantly better than those in the bilateral‐HI group. This study suggests the possibility of using pre‐ and intraoperative observation of CP origin to predict four HI patterns and even subsequent outcomes after tumor removal. This study provided possibility to use the pre‐ and intraoperative observation of craniopharyngiomas origin to predict the four hypothalamic injury patterns and subsequent outcomes after tumor removal.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc
• Subject: Adolescent / Adult / Aged / Child / Clinical Cancer Research / Cognitive ability / craniopharyngioma / Craniopharyngioma - complications / Craniopharyngioma - diagnostic imaging / Craniopharyngioma - pathology / Craniopharyngioma - surgery / Diabetes / Diabetes insipidus / endoscopic endonasal approach / Endoscopy / Female / Humans / hypothalamic injury / Hypothalamus / Hypothalamus - diagnostic imaging / Hypothalamus - pathology / Hypothalamus - physiopathology / Hypothalamus - surgery / Male / Middle Aged / Natural Orifice Endoscopic Surgery - adverse effects / Neoplasia / Neoplasm Invasiveness / neuropsychological function / Original Research / Patients / Pituitary / Pituitary Neoplasms - complications / Pituitary Neoplasms - diagnostic imaging / Pituitary Neoplasms - pathology / Pituitary Neoplasms - surgery / Postoperative Complications - diagnostic imaging / Postoperative Complications - etiology / Postoperative Complications - physiopathology / Postoperative Complications - psychology / Quality of life / Retrospective Studies / Risk Assessment / Risk Factors / Sleep / Surgeons / Surgery / surgical outcome / Time Factors / Treatment Outcome / tumor origin / Tumors / Young Adult