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Comparative Study
. 2020 Dec;9(23):8950-8961.
doi: 10.1002/cam4.3589. Epub 2020 Nov 3.

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

Le Yang  1 , ShenHao Xie  1 , Bin Tang  1 , Xiao Wu  1 , ZhiGao Tong  1 , Chao Fang  1 , Han Ding  1 , YouYuan Bao  1 , SuYue Zheng  1 , Tao Hong  1
Affiliations
Comparative Study

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

Le Yang et al. Cancer Med. 2020 Dec.

Abstract

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.

Keywords: craniopharyngioma; endoscopic endonasal approach; hypothalamic injury; neuropsychological function; surgical outcome; tumor origin.

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Conflict of interest statement

The authors declare that they have no conflicts interests.

Figures

FIGURE 1
FIGURE 1
Pre‐ and post‐operative images and intraoperative findings of NO‐HI and Mild‐HI patterns
FIGURE 2
FIGURE 2
Pre‐ and post‐operative images and intraoperative findings of Unilateral‐HI and Bilateral‐HI patterns
FIGURE 3
FIGURE 3
Scheme of different CP origin and the correlation between different CP origins and HI patterns
FIGURE 4
FIGURE 4
Illustration of different growth patterns of CP origin classification and the HI patterns that might lead to
See this image and copyright information in PMC

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