Microstructural white matter alterations and hippocampal volumes are associated with cognitive deficits in craniopharyngioma

Abstract

ContextPatients with craniopharyngioma (CP) and hypothalamic lesions (HL) have cognitive deficits. Which neural pathways are affected is unknown.ObjectiveTo determine whether there is a relationship between microstructural white matter (WM) alterations detected with diffusion tensor imaging (DTI) and cognition in adults with childhood-onset CP.DesignA cross-sectional study with a median follow-up time of 22 (6–49) years after operation.SettingThe South Medical Region of Sweden (2.5 million inhabitants).ParticipantsIncluded were 41 patients (24 women, ≥17 years) surgically treated for childhood-onset CP between 1958–2010 and 32 controls with similar age and gender distributions. HL was found in 23 patients.Main outcome measuresSubjects performed cognitive tests and magnetic resonance imaging, and images were analyzed using DTI of uncinate fasciculus, fornix, cingulum, hippocampus and hypothalamus as well as hippocampal volumetry.ResultsRight uncinate fasciculus was significantly altered (P ≤ 0.01). Microstructural WM alterations in left ventral cingulum were significantly associated with worse performance in visual episodic memory, explaining approximately 50% of the variation. Alterations in dorsal cingulum were associated with worse performance in immediate, delayed recall and recognition, explaining 26–38% of the variation, and with visuospatial ability and executive function, explaining 19–29%. Patients who had smaller hippocampal volume had worse general knowledge (P = 0.028), and microstructural WM alterations in hippocampus were associated with a decline in general knowledge and episodic visual memory.ConclusionsA structure to function relationship is suggested between microstructural WM alterations in cingulum and in hippocampus with cognitive deficits in CP.

Management of hypothalamic disease in patients with craniopharyngioma

“…Craniopharyngiomas patients will benefit from the recent surge in international registries and collaborations that should yield a larger evidence base for treatment planning and management of complications, including multicentre randomized clinical trials (Table ). The advent of more sophisticated neuroimaging and functional neuroimaging, in tandem with in‐depth clinical phenotyping, should provide more information about the link between anatomical lesions and hypothalamic syndromes in CP; structural deficits have also been linked to neurocognitive problems in this population which are outside the scope of this review …”

Diagnosis, Background, and Treatment of Hypothalamic Damage in Craniopharyngioma

“…However, no severely disabled patients were included in the mentioned study [24]. The morbidity of CP includes cognitive dysfunction with attention deficits and impaired episodic memory and processing speed [81,82]. Patients with hypothalamic damage are more affected (Table 4) [24].…”

Social Cognition in Patients With Hypothalamic-Pituitary Tumors

“…The Beck Depression Inventory (BDI-II) (34) is a 21-item self-report measure of depressive symptoms experienced during the past 2 weeks. Higher scores indicate higher levels of depressive symptoms and scores are categorized as follows: minimal (9-19), mild (14)(15)(16)(17)(18)(19), moderate (20)(21)(22)(23)(24)(25)(26)(27)(28), and severe level of depressive symptoms . The State Trait Anxiety Inventory (STAI) (35) is a 40-item measure to assess trait and state anxiety by using two subscales with each 20 items.…”

“…Due to frequently observed tumor growth into the third ventricle, patients with hypothalamic involvement of the tumor also have a much higher risk to develop a hydrocephalus which then may lead to changes in the periventricular brain tissue ( 21 ) including brain regions involved in social-cognitive functioning such as the anterior cingulate cortex. In recent imaging studies with CP, findings obtained with diffusion tensor imaging (DTI), positron emission tomography (PET; F-18 fluorodeoxyglucose) and voxel-based morphometry (VBM), indicated changes in the hypothalamus, the medial prefrontal, orbitofrontal, and cingulate cortices, the hippocampus, amygdala, and insula, as well as their connections ( 9 , 10 , 22 ).…”