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Acta Neurochirurgica
Published in: Acta Neurochirurgica 2/2021

01-02-2021 | Obesity | Original Article - Pediatric Neurosurgery

Long-term outcomes following maximal safe resection in a contemporary series of childhood craniopharyngiomas

Authors: Sauradeep Sarkar, Shireen R. Chacko, Sophy Korula, Anna Simon, Sarah Mathai, Geeta Chacko, Ari George Chacko

Published in: Acta Neurochirurgica | Issue 2/2021

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Abstract

Background

The optimal management of pediatric craniopharyngiomas remains controversial. This study aimed to characterize long-term outcomes in a contemporary cohort of children undergoing surgery for craniopharyngiomas.

Methods

This was a retrospective review of 37 consecutive children who underwent surgery for craniopharyngioma with a median follow-up duration of 79 months (range 5–127 months). Patients were stratified by extent of resection (EOR) and need for adjuvant radiation therapy (RT). Imaging studies were reviewed to grade extent of hypothalamic involvement. Data on functional outcomes, pituitary function, and obesity were analyzed.

Results

Gross total resection was achieved in 16 patients (43.2%), near total resection in six patients (16.2%), and subtotal resection (STR) in 15 patients (40.5%). The recurrence-free survival rate was 81.1% and 70.3% at 5- and 10-year follow-up, respectively. Survival analysis showed superior disease control in patients undergoing STR + RT (p = 0.008). Functional outcomes were independent of EOR, postoperative RT or recurrence. Diabetes insipidus was present in 75% and 44.4% of patients required >2 hormone replacements at last follow-up. Obesity was present in 36.1% patients after treatment, and was associated with preoperative obesity (p = 0.019), preoperative hypothalamic involvement (p = 0.047) and STR + RT (p = 0.011).

Conclusions

Gross or near total resection may be achieved safely in almost 60% of cases; however, radical surgery does not eliminate the risk of recurrence. Over long-term follow-up, STR + RT offers the best disease control rates. Patients with preoperative hypothalamic involvement, obesity, and those with tumors not amenable to radical resection are at risk for developing obesity on long-term follow-up.
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Metadata
Title
Long-term outcomes following maximal safe resection in a contemporary series of childhood craniopharyngiomas
Authors
Sauradeep Sarkar
Shireen R. Chacko
Sophy Korula
Anna Simon
Sarah Mathai
Geeta Chacko
Ari George Chacko
Publication date
01-02-2021
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 2/2021
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-020-04591-4

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