Investigating the role of hypothalamic tumor involvement in sleep and cognitive outcomes among children treated for craniopharyngioma

Abstract

Objective: Despite excellent survival prognosis, children treated for craniopharyngioma experience significant morbidity. We examined the role of hypothalamic involvement (HI) in excessive daytime sleepiness (EDS) and attention regulation in children enrolled on a Phase II trial of limited surgery and proton therapy. Methods: Participants completed a sleep evaluation (N ¼ 62) and a continuous performance test (CPT) during functional magnetic resonance imaging (fMRI; n ¼ 29) prior to proton therapy. Results: EDS was identified in 76% of the patients and was significantly related to increased HI extent (p ¼ .04). There was no relationship between CPT performance during fMRI and HI or EDS. Visual examination of group composite fMRI images revealed greater spatial extent of activation in frontal cortical regions in patients with EDS, consistent with a compensatory activation hypothesis. Conclusion: Routine screening for sleep problems during therapy is indicated for children with craniopharyngioma, to optimize the timing of interventions and reduce long-term morbidity.