Effects of Craniotomy and Endoscopic Endonasal Transsphenoidal Surgery on Bodyweight in Adult-Onset Craniopharyngioma: A Single-Center Retrospective Study

Abstract

Craniopharyngioma (CP) is a histologically benign tumor with high mortality and morbidity. Although surgical treatment is essential in managing CP, the best surgical approach is debated. A retrospective cohort of 117 patients with adult-onset CP (AOCP) treated between 2018 and 2020 in Beijing Tiantan Hospital was identified and examined. The effects of traditional craniotomy (TC) and endoscopic endonasal transsphenoidal surgery (EETS) on the extent of surgical resection, hypothalamic involvement (HI), postoperative endocrine function, and postoperative weight were compared in the cohort. The cohort comprised 43 males and 74 females, divided into the TC (n = 59) and EETS (n = 58) groups. The EETS group possessed a higher rate of gross total resection (GTR) (adjusted odds ratio (aOR) = 4.08, p = 0.029) and improved HI (aOR = 2.58, p = 0.041) than the TC group. Worse postoperative HI was only observed in the TC group (5 patients). The EETS was associated with fewer adverse hormonal outcomes, including posterior pituitary dysfunction (aOR = 0.386, p = 0.040) and hypopituitarism (aOR = 0.384, p = 0.031). Additionally, multivariate logistic regression analysis confirmed that EETS was related to fewer cases of weight gain >5% (aOR = 0.376, p = 0.034), significant weight change (aOR = 0.379, p = 0.022), and postoperative obesity (aOR = 0.259, p = 0.032). Compared to TC, EETS shows advantages in accomplishing GTR, hypothalamus protection, postoperative endocrine function reservation, and postoperative weight control. These data suggest that the EETS deserves more application in managing patients with AOCP.

Clinical Significance of Plasma Leptin and Its Receptors mRNA Expression in Craniopharyngiomas: A Prospective Study

“…For adults, we used standard WHO criteria to define overweight (BMI ≥ 25 kg/m 2 ) and obesity (BMI ≥ 30 kg/m 2 ). Consistent with one of our previous studies, postoperative BMI changes ≥5% were considered significant weight changes [15].…”

“…Demographic characteristics (e.g., age, sex, and BMI), tumor features (e.g., tumor size, tumor type (cystic or not), and hypothalamic involvement (HI)), and relevant follow-up data (e.g., length of follow-up, recurrence, and postsurgery BMI) were collected for the analysis. Preoperative magnetic resonance imaging (MRI) was used to identify the maximum diameter of the tumor in three dimensions; tumor volume and cyst volume were calculated using the standardized method: volume = 4/3 × π × (a/2 × b/2 × c/2), where the longest diameter in each plane measured variables [15]. Cystic tumors are those with more than 50% cystic tumor volume [15].…”

“…Preoperative magnetic resonance imaging (MRI) was used to identify the maximum diameter of the tumor in three dimensions; tumor volume and cyst volume were calculated using the standardized method: volume = 4/3 × π × (a/2 × b/2 × c/2), where the longest diameter in each plane measured variables [15]. Cystic tumors are those with more than 50% cystic tumor volume [15]. Three-dimensional computed tomography was completed preoperatively to confirm the presence of calcification.…”

“…Patients were followed for postoperative BMI from primary surgery until the date of progression/recurrence, receiving radiotherapy, death, or last follow-up (1 March 2023), whichever came first [15]. In this study, progression-free survival (PFS) was defined as the time from operation to progression/recurrence or death, and tumor progression/recurrence was defined as the appearance of new lesions on MRI or the enlargement of residual tumors on follow-up [18].…”

The Clinical Significance of Inflammatory Mediators in Predicting Obesity and Progression-Free Survival in Patients with Craniopharyngioma

“…The tumor volume and cyst volume were approximately calculated using the following formula: volume = 4/3 × π × (a/2 × b/2 × c/2), where a, b, and c represent the maximum diameters of the tumor in each of the three dimensions [20]. A tumor with a cystic component comprising more than 50% of the total volume was classi ed as a cystic tumor [14,20].…”