Craniopharyngioma and hypothalamic obesity in children

Background and purpose Obesity is a major concern in children treated for craniopharyngioma and is caused by hypothalamic damage. The role of aggressive surgical removal has been questioned, leading some authors to recommend a minimalist approach. In order to test this hypothesis, we decided to stud...

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Bibliographic Details
Published in:Child's nervous system 2009-03, Vol.25 (3), p.347-352
Main Authors: Vinchon, Matthieu, Weill, Jacques, Delestret, Isabelle, Dhellemmes, Patrick
Format: Article
Language:English
Subjects:
Adolescent
Body Mass Index
Cerebral neoplasms
Child
Child, Preschool
Childhood tumors
Craniopharyngioma
Craniopharyngioma - complications
Craniopharyngioma - pathology
Craniopharyngioma - surgery
Female
Follow-Up Studies
France
Humans
Hypothalamic dysfunction
Hypothalamus - pathology
Hypothalamus - physiopathology
Male
Medicine
Medicine & Public Health
Neurosciences
Neurosurgery
Neurosurgical Procedures
obesity
Obesity - epidemiology
Obesity - etiology
Obesity - physiopathology
Obesity, Morbid - etiology
Original Paper
Pituitary Neoplasms - complications
Pituitary Neoplasms - pathology
Pituitary Neoplasms - surgery
Postoperative Complications
Prognosis
relapse
Retrospective Studies
Risk Factors
Treatment Outcome
Weight Gain
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Summary:Background and purpose Obesity is a major concern in children treated for craniopharyngioma and is caused by hypothalamic damage. The role of aggressive surgical removal has been questioned, leading some authors to recommend a minimalist approach. In order to test this hypothesis, we decided to study obesity in craniopharyngioma and the factors related to it. Materials and methods We reviewed retrospectively our series of pediatric craniopharyngiomas operated since 1981. The body-mass index (BMI) was calculated for each patient pre- and at several intervals postoperatively and expressed as standard deviations (SD) adjusted for age and gender. Results We operated on 45 cases, which were followed up for a mean duration of 11.0 years. Initial resection was total in 25 cases (55.6%). No patient died because of surgery or tumor progression; two died with delay presumably because of endocrine failure. At last control, 28 patients (62%) had obesity (BMI over +2SD). Hypothalamic involvement was significantly correlated with preoperative and postoperative BMI. Subtotal tumor resection was significantly associated with obesity at last control. Reoperation for tumor recurrence was associated with a significantly higher BMI. Conclusions Our results suggest that obesity results from hypothalamic lesions caused by the tumor rather than by surgery. The postoperative weight gain appears to result from the continued impact of preoperative hypothalamic damage. The high rate of tumor recurrence in children, with the risk of additional damage to the hypothalamus, incites us to recommend total resection whenever it appears safe during initial surgery.
ISSN:0256-7040
1433-0350
DOI:10.1007/s00381-008-0754-x