Abstract
Quality of life of craniopharyngioma patients can be severely impaired by derangement of hypothalamic function. A classification, taking into account preoperative hypothalamic damage, evaluated by magnetic resonance imaging (MRI), and correlating it with postoperative weight change is still missing in the literature. The aim of our study is to identify objective radiological criteria as preoperative prognostic factors for hypothalamic damage. Pre- and post-operative MRI and clinical data of 47 patients, treated at our Institution for craniopharyngioma, were retrospectively analyzed, based on radiological variables, identified as prognostic factor for hypothalamic involvement. Main factors associated with postoperative obesity were hypothalamic hyperintensity in T2-weighted/FLAIR imaging (p < 0.033), mammillary body involvement according to Müller classification (p < 0.020), unidentifiable pituitary stalk (p < 0.001), dislocated chiasm (p < 0.038), either not visible infundibular recess (p < 0.019) or unrecognizable supra-optic recess (p < 0.004), and retrochiasmatic tumor extension (p < 0.019). Accordingly, postoperative hypothalamic syndrome was associated with peritumoral edema in T2-weighted/FLAIR images (p < 0.003), unidentifiable hypothalamus (p < 0.024), hypothalamic compression (p < 0.006), fornix displacement (p < 0.032), and unrecognizable supra-optic recess (p < 0.031). Ultimately, variables identified as predictive factors of postoperative hypothalamic syndrome were the degree of hypothalamic involvement according to the classification described by Sainte-Rose and Puget (p < 0.002; grade 0 vs 2 p < 0.001), Van Gompel (p < 0.002; grade 0 vs 1, p < 0.027; and grade 0 vs 2, p < 0.002), and Muller (p < 0.006; grade 0 vs 1, p < 0.05; and grade 0 vs 2, p < 0.004). The identification of these predictive factors will help to define and score the preoperative hypothalamic involvement in craniopharyngioma patients.
Similar content being viewed by others
References
J. Flitsch, H.L. Muller, T. Burkhardt, Surgical strategies in childhood craniopharyngioma. Front. Endocrinol. 2, 96 (2011). doi:10.3389/fendo.2011.00096
P. Mortini, M. Losa, G. Pozzobon, R. Barzaghi, M. Riva, S. Acerno, D. Angius, G. Weber, G. Chiumello, M. Giovanelli, Neurosurgical treatment of craniopharyngioma in adults and children: early and long-term results in a large case series. J. Neurosurg. 114(5), 1350–1359 (2011). doi:10.3171/2010.11.JNS10670
C.J. De Vile, D.B. Grant, B.E. Kendall, B.G. Neville, R. Stanhope, K.E. Watkins, R.D. Hayward, Management of childhood craniopharyngioma: can the morbidity of radical surgery be predicted? J. Neurosurg. 85(1), 73–81 (1996). doi:10.3171/jns.1996.85.1.0073
H.L. Muller, U. Gebhardt, N. Etavard-Gorris, E. Korenke, M. Warmuth-Metz, R. Kolb, N. Sorensen, G. Calaminus, Prognosis and sequela in patients with childhood craniopharyngioma—results of HIT-ENDO and update on KRANIOPHARYNGEOM 2000. Klin. Padiatr. 216(6), 343–348 (2004). doi:10.1055/s-2004-832339
C.J. de Vile, D.B. Grant, R.D. Hayward, B.E. Kendall, B.G. Neville, R. Stanhope, Obesity in childhood craniopharyngioma: relation to post-operative hypothalamic damage shown by magnetic resonance imaging. J. Clin. Endocrinol. Metab. 81(7), 2734–2737 (1996)
T.E. Merchant, E.N. Kiehna, R.A. Sanford, R.K. Mulhern, S.J. Thompson, M.W. Wilson, R.H. Lustig, L.E. Kun, Craniopharyngioma: the St. Jude Children’s Research Hospital experience 1984–2001. Int. J. Radiat. Oncol. Biol. Phys. 53(3), 533–542 (2002)
A. Poretti, M.A. Grotzer, K. Ribi, E. Schonle, E. Boltshauser, Outcome of craniopharyngioma in children: long-term complications and quality of life. Dev. Med. Child Neurol. 46(4), 220–229 (2004)
J.J. Lemaire, H. Nezzar, L. Sakka, Y. Boirie, D. Fontaine, A. Coste, G. Coll, A. Sontheimer, C. Sarret, J. Gabrillargues, A. De Salles, Maps of the adult human hypothalamus. Surg. Neurol. Int. 4(Suppl 3), S156–S163 (2013). doi:10.4103/2152-7806.110667
D.N. Louis, H. Ohgaki, O.D. Wiestler, W.K. Cavenee, P.C. Burger, A. Jouvet, B.W. Scheithauer, P. Kleihues, The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 114(2), 97–109 (2007). doi:10.1007/s00401-007-0243-4
P. Mortini, F. Gagliardi, N. Boari, F. Roberti, A.J. Caputy, The combined interhemispheric subcommissural translaminaterminalis approach for large craniopharyngiomas. World Neurosurg. (2012). doi:10.1016/j.wneu.2012.06.042
P. Mortini, F. Gagliardi, N. Boari, M. Losa, Surgical strategies and modern therapeutic options in the treatment of craniopharyngiomas. Crit. Rev. Oncol. Hematol. (2013). doi:10.1016/j.critrevonc.2013.07.013
P. Mortini, L.R. Barzaghi, C. Serra, V. Orlandi, S. Bianchi, M. Losa, Visual outcome after fronto-temporo-orbito-zygomatic approach combined with early extradural and intradural optic nerve decompression in tuberculum and diaphragma sellae meningiomas. Clin. Neurol. Neurosurg. 114(6), 597–606 (2012). doi:10.1016/j.clineuro.2011.12.021
L.R. Barzaghi, M. Medone, M. Losa, S. Bianchi, M. Giovanelli, P. Mortini, Prognostic factors of visual field improvement after trans-sphenoidal approach for pituitary macroadenomas: review of the literature and analysis by quantitative method. Neurosurg. Rev. 35(3), 369–378 (2012). doi:10.1007/s10143-011-0365-y. discussion 378–369
H.L. Muller, U. Gebhardt, C. Teske, A. Faldum, I. Zwiener, M. Warmuth-Metz, T. Pietsch, F. Pohl, N. Sorensen, G. Calaminus, Study Committee of K, Post-operative hypothalamic lesions and obesity in childhood craniopharyngioma: results of the multinational prospective trial KRANIOPHARYNGEOM 2000 after 3-year follow-up. Eur. J. Endocrinol. 165(1), 17–24 (2011). doi:10.1530/EJE-11-0158
S. Puget, M. Garnett, A. Wray, J. Grill, J.L. Habrand, N. Bodaert, M. Zerah, M. Bezerra, D. Renier, A. Pierre-Kahn, C. Sainte-Rose, Pediatric craniopharyngiomas: classification and treatment according to the degree of hypothalamic involvement. J. Neurosurg. 106(1 Suppl), 3–12 (2007). doi:10.3171/ped.2007.106.1.3
C. Sainte-Rose, S. Puget, A. Wray, M. Zerah, J. Grill, R. Brauner, N. Boddaert, A. Pierre-Kahn, Craniopharyngioma: the pendulum of surgical management. Child’s Nerv. Syst. 21(8–9), 691–695 (2005). doi:10.1007/s00381-005-1209-2
J.J. Van Gompel, T.B. Nippoldt, D.M. Higgins, F.B. Meyer, Magnetic resonance imaging-graded hypothalamic compression in surgically treated adult craniopharyngiomas determining postoperative obesity. Neurosurg. Focus 28(4), E3 (2010). doi:10.3171/2010.1.FOCUS09303
K.C. Wang, S.K. Kim, G. Choe, J.G. Chi, B.K. Cho, Growth patterns of craniopharyngioma in children: role of the diaphragm sellae and its surgical implication. Surg. Neurol. 57(1), 25–33 (2002)
I.S. Ciric, J.W. Cozzens, Craniopharyngiomas: transsphenoidal method of approach–for the virtuoso only? Clin. Neurosurg. 27, 169–187 (1980)
M. Samii, M. Tatagiba, Surgical management of craniopharyngiomas: a review. Neurol. Med. Chir. 37(2), 141–149 (1997)
M.G. Yasargil, M. Curcic, M. Kis, G. Siegenthaler, P.J. Teddy, P. Roth, Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients. J. Neurosurg. 73(1), 3–11 (1990). doi:10.3171/jns.1990.73.1.0003
H.J. Hoffman, M. De Silva, R.P. Humphreys, J.M. Drake, M.L. Smith, S.I. Blaser, Aggressive surgical management of craniopharyngiomas in children. J. Neurosurg. 76(1), 47–52 (1992). doi:10.3171/jns.1992.76.1.0047
J.M. Pascual, R. Carrasco, R. Prieto, F. Gonzalez-Llanos, F. Alvarez, J.M. Roda, Craniopharyngioma classification. J. Neurosurg. 109(6), 1180–1182 (2008). doi:10.3171/JNS.2008.109.12.1180. author reply 1182–1183
H.J. Hoffman, Surgical management of craniopharyngioma. Pediatr. Neurosurg. 21(Suppl 1), 44–49 (1994)
J. Steno, M. Malacek, I. Bizik, Tumor-third ventricular relationships in supradiaphragmatic craniopharyngiomas: correlation of morphological, magnetic resonance imaging, and operative findings. Neurosurgery 54(5), 1051–1058 (2004). discussion 1058–1060
M.R. Garnett, S. Puget, J. Grill, C. Sainte-Rose, Craniopharyngioma. Orphanet J. Rare. Dis. 2, 18 (2007). doi:10.1186/1750-1172-2-18
S. Meuric, R. Brauner, C. Trivin, J.C. Souberbielle, M. Zerah, C. Sainte-Rose, Influence of tumor location on the presentation and evolution of craniopharyngiomas. J. Neurosurg. 103(5 Suppl), 421–426 (2005). doi:10.3171/ped.2005.103.5.0421
H.L. Muller, A. Emser, A. Faldum, G. Bruhnken, N. Etavard-Gorris, U. Gebhardt, R. Oeverink, R. Kolb, N. Sorensen, Longitudinal study on growth and body mass index before and after diagnosis of childhood craniopharyngioma. J. Clin. Endocrinol. Metab. 89(7), 3298–3305 (2004). doi:10.1210/jc.2003-03175189/7/3298
J. Duff, F.B. Meyer, D.M. Ilstrup, E.R. Laws, C.D. Schleck, B.W. Scheithauer, Long-term outcomes for surgically resected craniopharyngiomas. Neurosurgery 46(2), 291–302 (2000). discussion 302–295
R.H. Lustig, Hypothalamic obesity after craniopharyngioma: mechanisms, diagnosis, and treatment. Front. Endocrinol. (Lausanne) 2, 60 (2011). doi:10.3389/fendo.2011.00060
R.H. Lustig, S.R. Post, K. Srivannaboon, S.R. Rose, R.K. Danish, G.A. Burghen, X. Xiong, S. Wu, T.E. Merchant, Risk factors for the development of obesity in children surviving brain tumors. J. Clin. Endocrinol. Metab. 88(2), 611–616 (2003)
S. Higashi, J. Yamashita, H. Fujisawa, Y. Yamamoto, M. Kadoya, “Moustache” appearance in craniopharyngiomas: unique magnetic resonance imaging and computed tomographic findings of perifocal edema. Neurosurgery 27(6), 993–996 (1990)
X.E. Shi, B. Wu, Z.Q. Zhou, T. Fan, Y.L. Zhang, Microsurgical treatment of craniopharyngiomas: report of 284 patients. Chin. Med. J. (Engl) 119(19), 1653–1663 (2006)
J. Steno, I. Bizik, A. Steno, V. Matejcik, Craniopharyngiomas in children: how radical should the surgeon be? Childs Nerv. Syst. 27(1), 41–54 (2011). doi:10.1007/s00381-010-1330-8
J.M. Pascual, R. Prieto, R. Carrasco, Infundibulo-tuberal or not strictly intraventricular craniopharyngioma: evidence for a major topographical category. Acta Neurochir. (Wien) 153(12), 2403–2425 (2011). doi:10.1007/s00701-011-1149-4. discussion 2426
R. Fahlbusch, J. Honegger, W. Paulus, W. Huk, M. Buchfelder, Surgical treatment of craniopharyngiomas: experience with 168 patients. J. Neurosurg. 90(2), 237–250 (1999). doi:10.3171/jns.1999.90.2.0237
R. Van Effenterre, A.L. Boch, Craniopharyngioma in adults and children: a study of 122 surgical cases. J. Neurosurg. 97(1), 3–11 (2002). doi:10.3171/jns.2002.97.1.0003
N. Karavitaki, S. Cudlip, C.B. Adams, J.A. Wass, Craniopharyngiomas. Endocr. Rev. 27(4), 371–397 (2006). doi:10.1210/er.2006-0002
A.L. Albright, C.G. Hadjipanayis, L.D. Lunsford, D. Kondziolka, I.F. Pollack, P.D. Adelson, Individualized treatment of pediatric craniopharyngiomas. Child’s Nerv. Syst. 21(8–9), 649–654 (2005). doi:10.1007/s00381-005-1185-6
L.H. Chen, Y.S. Liu, X.R. Yuan, J.S. Fang, J.R. Ma, J. Xi, Z.Q. Yang, L. Huo, Microsurgical treatment for craniopharyngioma combined transorbital-subfrontal and temporal craniotomy. Zhonghua Wai Ke Za Zhi 41(4), 282–285 (2003)
E.N. Gonc, N. Yordam, A. Ozon, A. Alikasifoglu, N. Kandemir, Endocrinological outcome of different treatment options in children with craniopharyngioma: a retrospective analysis of 66 cases. Pediatr. Neurosurg. 40(3), 112–119 (2004). doi:10.1159/000079852
B.M. Hofmann, A. Hollig, C. Strauss, R. Buslei, M. Buchfelder, R. Fahlbusch, Results after treatment of craniopharyngiomas: further experiences with 73 patients since 1997. J. Neurosurg. 116(2), 373–384 (2012). doi:10.3171/2011.6.JNS081451
S.K. Kim, K.C. Wang, S.H. Shin, G. Choe, J.G. Chi, B.K. Cho, Radical excision of pediatric craniopharyngioma: recurrence pattern and prognostic factors. Child’s Nerv. Syst. 17(9), 531–536 (2001). discussion 537
M. Kitano, M. Taneda, Extended transsphenoidal surgery for suprasellar craniopharyngiomas: infrachiasmatic radical resection combined with or without a suprachiasmatic trans-lamina terminalis approach. Surg. Neurol. 71(3), 290–298 (2009). doi:10.1016/j.surneu.2007.11.014. discussion 298
Y.Y. Lee, T.T. Wong, Y.T. Fang, K.P. Chang, Y.W. Chen, D.M. Niu, Comparison of hypothalamopituitary axis dysfunction of intrasellar and third ventricular craniopharyngiomas in children. Brain Dev. 30(3), 189–194 (2008). doi:10.1016/j.braindev.2007.07.011
G. Lena, A. PazParedes, D. Scavarda, B. Giusiano, Craniopharyngioma in children: Marseille experience. Child’s Nerv. Syst. 21(8–9), 778–784 (2005). doi:10.1007/s00381-005-1207-4
Y. Minamida, T. Mikami, K. Hashi, K. Houkin, Surgical management of the recurrence and regrowth of craniopharyngiomas. J. Neurosurg. 103(2), 224–232 (2005). doi:10.3171/jns.2005.103.2.0224
K. Ohmori, J. Collins, T. Fukushima, Craniopharyngiomas in children. Pediatr. Neurosurg. 43(4), 265–278 (2007). doi:10.1159/000103306
R. Shirane, T. Hayashi, T. Tominaga, Fronto-basal interhemispheric approach for craniopharyngiomas extending outside the suprasellar cistern. Child’s Nerv. Syst. 21(8–9), 669–678 (2005). doi:10.1007/s00381-005-1206-5
I.J. Sosa, M.D. Krieger, J.G. McComb, Craniopharyngiomas of childhood: the CHLA experience. Child’s Nerv. Syst. 21(8–9), 785–789 (2005). doi:10.1007/s00381-005-1225-2
D.C. Stripp, A. Maity, A.J. Janss, J.B. Belasco, Z.A. Tochner, J.W. Goldwein, T. Moshang, L.B. Rorke, P.C. Phillips, L.N. Sutton, H.K. Shu, Surgery with or without radiation therapy in the management of craniopharyngiomas in children and young adults. Int. J. Radiat. Oncol. Biol. Phys. 58(3), 714–720 (2004). doi:10.1016/S0360-3016(03)01570-0
D. Thompson, K. Phipps, R. Hayward, Craniopharyngioma in childhood: our evidence-based approach to management. Child’s Nerv. Syst. 21(8–9), 660–668 (2005). doi:10.1007/s00381-005-1210-9
T. Tomita, R.M. Bowman, Craniopharyngiomas in children: surgical experience at Children’s Memorial Hospital. Child’s Nerv. Syst. 21(8–9), 729–746 (2005). doi:10.1007/s00381-005-1202-9
Y.Q. Zhang, Z.Y. Ma, Z.B. Wu, S.Q. Luo, Z.C. Wang, Radical resection of 202 pediatric craniopharyngiomas with special reference to the surgical approaches and hypothalamic protection. Pediatr. Neurosurg. 44(6), 435–443 (2008). doi:10.1159/000172965
G. Zuccaro, Radical resection of craniopharyngioma. Child’s Nerv. Syst. 21(8–9), 679–690 (2005). doi:10.1007/s00381-005-1201-x
N. Saeki, H. Murai, M. Kubota, N. Fujimoto, T. Iuchi, A. Yamaura, K. Sunami, Heavily T2 weighted MR images of anterior optic pathways in patients with sellar and parasellar tumours—prediction of surgical anatomy. Acta Neurochir. (Wien) 144(1), 25–35 (2002). doi:10.1007/s007010200002
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare that they have no conflict of interest.
Human and animal rights and informed consent
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Mortini, P., Gagliardi, F., Bailo, M. et al. Magnetic resonance imaging as predictor of functional outcome in craniopharyngiomas. Endocrine 51, 148–162 (2016). https://doi.org/10.1007/s12020-015-0683-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12020-015-0683-x