035. Does subtotal resection ameliorate subsequent hypothalamic morbidity in pediatric craniopharyngioma: A 30-year observational study

Authors: Kathrin Zimmerman

Surgical management of pediatric craniopharyngioma remains controversial, largely due to long-term risks of hypothalamic and endocrine dysfunction (obesity and panhypopituitarism). It is not established with certainty the appropriate extent of resection to minimize these long-term risks. The purpose of this study is to establish metrics of hypothalamic dysfunction and compare outcomes between gross total resection (GTR) and sub-total resection (STR).Methods: Retrospective chart review was conducted of children who underwent surgical resection for craniopharyngioma at Children’s of Alabama between 1990-2020. Sub-total resection (STR) was defined by the attending surgeon in the operative note as intentional avoidance of tumor resection that intra-operatively posed a high risk of hypothalamic/pituitary stalk injury. Endocrine function was assessed via hormone supplementation regimen and body mass index (BMI). BMI was recorded at diagnosis, 6-12 months post-operation, and at most recent follow-up. Z-scores for BMI were calculated using CDC-LMS method.
Cohort included 24 females and 15 males (age range 1 month to 16 years). Initial treatment was cyst decompression (CD) in 5, STR in 13, and GTR in 21. Average long-term follow-up after surgery was 6.35 years (range 0.1-29.84). On univariable analysis there is initially a significant increase in BMI in patients undergoing GTR when compared to those undergoing STR or CD (RR 2.57, 95% CI 1.31-5.03) which is not seen beyond 2 years. In multivariable analysis, patients over the age of 10 seemed to be the most affected and at higher risk of developing significant hypothalamic dysfunction. There was no significant difference in pituitary or neurological function between the STR/CD and GTR groups at 12–24-month and most recent follow up.
Both STR and GTR of craniopharyngioma were associated with significant endocrine morbidity. Prior to resection, these likely consequences should be discussed with families. Post-operative protocols should include early nutritional and endocrinological intervention.