Tumor origin and growth pattern at diagnosis and surgical hypothalamic damage predict obesity in pediatric craniopharyngioma

Abstract

Severe obesity is a major problem in pediatric craniopharyngioma. We investigated whether tumor origin, growth pattern, and surgical damage predict obesity in pediatric craniopharyngioma. Subjects were 58 patients (30 males) with no tumor recurrence during the first postoperative 18 months. Preoperative hypothalamic involvement was classified into no (pre-G0, n = 19), little (pre-G1, n = 21), and severe (pre-G2, n = 18) involvement groups based on sub- or supradiaphragmatic tumor origin and growth patterns. Postoperative hypothalamic involvement was classified into no (post-G0, n = 4), minimal (post-G1, n = 19), and significant (post-G2, n = 35) involvement groups according to follow-up imaging. The prevalence of obesity increased from 13.2 % at diagnosis (mean age = 8.1 years) to 37.9 % at last follow-up (mean duration = 9.1 years). Only the body mass index (BMI) Z-score increment of the first postoperative year (first-year ΔBMI-Z) was significant (P = 0.007). Both the preoperative BMI-Z (P = 0.001) and the first-year ΔBMI-Z (P = 0.017) showed an increasing trend from the pre-G0 to pre-G1 to pre-G2 group. For the 40 patients with pre-G0 or pre-G1, the first-year ΔBMI-Z was higher in the post-G2 group than the post-G1 group (0.02 ± 0.91 vs. 0.89 ± 0.72, P = 0.003). Tumor origin and growth pattern affect preoperative BMI-Z and postoperative weight gain. Despite little or no hypothalamic involvement at diagnosis, surgical damage contributes to postoperative weight gain in patients with craniopharyngioma. © 2013 The Author(s).