Bariatric Surgery Following Treatment for Craniopharyngioma: A Systematic Review and Individual-Level Data Meta-Analysis

Abstract

Objectives: Craniopharyngiomas are rare low-grade tumors located in the hypothalamic and/or pituitary region. Hypothalamic involvement and treatment resulting in hypothalamic damage are known to lead to development of "hypothalamic obesity" (HyOb) in 50% of cases. The management of HyOb, associated with eating disorders and rapid comorbidities, is an important issue. Bariatric surgery is the most effective therapy for weight loss in patients with severe exogenous obesity. The aim of this systematic review and meta-analysis was to determine the 12-month outcome of bariatric surgery for HyOb due to craniopharyngioma treatment. Methods and Results:Relevant studies were identified by searches of the MEDLINE and EMBASE databases until January 2013. A total of 21 cases were included: 6 with adjustable gastric banding, 8 with sleeve gastrectomy, 6 with Roux-en-Y gastric bypass, and 1 with biliopancreatic diversion. After data pooling, mean weight difference was Ϫ20.9 kg after 6 months (95% confidence interval [CI], Ϫ35.4, Ϫ6.3) and Ϫ15.1 kg after 12 months (95% CI, Ϫ31.7, ϩ1.4). The maximal mean weight loss was achieved by the gastric bypass group: Ϫ31.0 kg (95% CI, Ϫ77.5, ϩ15.5) and Ϫ33.7 kg (95% CI, Ϫ80.7, ϩ13.3) after 6 and 12 months, respectively. Conclusions:In this largest ever published study on the effect of bariatric surgery on obesity after craniopharyngioma treatment, we observed an important weight loss after 1 year of follow-up. Larger studies are warranted to establish appropriate selection criteria and the best surgical technique to perform bariatric surgery. (J Clin Endocrinol Metab 98: 2239 -2246, 2013) C raniopharyngiomas are benign, slow-growing tumors that are located within the sellar and parasellar region of the central nervous system. There are 2 histological types: the adamantinomatous tumors, mostly seen in children, which arise from epithelial remnants of the Rathke's pouch; and the squamous papillary form, seen in adults. The incidence rate ranges from 0.5 to 2 per million subjects/year, with a peak between 5 and 14 years of age, although craniopharyngiomas can occur at any age (1).Tumor resection, with or without radiotherapy, represents the therapeutic standard of care. After treatment, obesity and eating disorders are observed in 40 -50% of patients (2-4). Weight gain is also observed at diagnosis before treatment in some patients. Risk factors for the development of obesity after treatment of craniopharyngioma include younger age at diagnosis, presence of endocrinopathy whatever type, initial symptoms of intracranial hypertension, greater body mass index (BMI) at diagnosis, familial predisposition for obesity, and hypothalamic involvement. In addition, pterional surgery, multiple surgery, and hypothalamic irradiation with doses greater than 51 Gy have been associated with the development of obesity (3,(5)(6)(7).The cause of weight gain in this setting is incompletely understood, but it is believed to be due to "endogenous" mechanisms, rather than the more common form of "exogenous" obesit...

Interventions for managing weight change following paediatric acquired brain injury: a systematic review

“…Nineteen different interventions were used in the retrieved studies in total. Specified diagnoses were: craniopharyngioma (n=564, 74%), [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] medulloblastoma (n=94, 12%), 23,33,34 primary neuroectodermal tumour (n=10, 1%), 33,34 unspecified brain tumour (n=44, 6%), [35][36][37][38][39] unspecified brain trauma (n=2, 0.3%), 40 meningitis (n=1, 0.1%), 16 structural hypothalamic lesions (n=12, 2%), 41 astrocytoma (n=9, 1%), 22,23 germinioma (n=6, 0.8%), 22,23,26 optic pathway glioma (n=2, 0.3%), 22,39 lipoma (n=1, 0.1%), 26 hamartoma (n=1, 0.1%), 26 germ cell tumour (n=1, 0.1%), 42 and glioma (n=1, 0.1%). 26 In 11 cases (1%), patients could not be disaggregated from the sample by diagnosis.…”

“…18,29,30 A further surgical approach found to be effective in management of weight gain in this group was bariatric surgery including truncal vagotomy, 27 laparoscopic adjustable gastric band, [13][14][15]28,31,32 sleeve gastrostomy, 13,14,31,32 gastric bypass, 31 and Roux-en-Y gastric bypass. 21,25,32 These studies suggest that such surgical techniques may be effective in reducing BMI 13,14,21,25,27,28 as well as stabilizing weight gain. 31 Consequently, there is a potential benefit of bariatric surgery in children for whom pharmacological interventions have proven unsuccessful.…”

“…Nineteen different interventions were used in the retrieved studies in total. Specified diagnoses were: craniopharyngioma (n=564, 74%), [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] 42 and glioma (n=1, 0.1%). 26 In 11 cases (1%), patients could not be disaggregated from the sample by diagnosis.…”

Hypothalamic Obesity: Prologue and Promise

“…That patient is reported as maintaining a BMI of 50 2.5 years after his surgery (the BMI was 25 at diagnosis and peaked at 63 prior to surgery) [31]. A meta-analysis of 21 CP survivors (8 of whom were adolescents) with HO who underwent gastric bypass showed varying degrees of weight loss and a lowest postsurgery BMI of 34 [36]. The Roux-en-Y procedure was found to be superior to gastric banding or sleeve gastrectomy.…”

Craniopharyngioma – Pediatric Management

“…In a systematic review and meta-analysis of the literature, Bretault et al (2013) analyzed the 12-month outcomes after bariatric surgery for hypothalamic obesity due to craniopharyngioma treatment. At 1 year, of 18 cases with follow-up data, six had lost more than 20% of their initial weight; all had undergone either Roux Y gastric bypass (n ¼ 3), sleeve gastrectomy, (n ¼ 2), or biliopancreatic diversion (n ¼ 1).…”