title: The impact of the site of origin and rate of tumour growth on clinical outcome in children with craniopharyngiomas.
abstract: OBJECTIVE
  Data on many predictors of hypothalamic-pituitary axis dysfunction associated with childhood craniopharyngioma (CP) are rather inconsistent, probably reflecting the variable but as yet unclarified growth pattern of these tumours. The aim of this study was to define the determinative role of tumour growth pattern on hypothalamic-pituitary axis function and outcomes for childhood CPs.
  
  
  METHODS
  The authors retrospectively analysed the records of 81 consecutive children with primary CP who underwent a uniform treatment paradigm of attempted radical resection performed by a single surgeon. The patients were divided into two subgroups based on tumour location and growth patterns: group A (infra-diaphragmatic sellar tumours: 34 cases) and group B [third ventricular floor (3rd VF) tumours: 47 cases]. The children's pre- and postsurgical endocrinological and hypothalamic disturbances were compared. Pituitary function and hypothalamic statues were quantitatively assessed using classification systems proposed in the previous studies.
  
  
  RESULTS
  Preoperative pituitary function was more severely compromised in patients in group A than those in group B and deteriorated significantly following resection in both groups. (Average pituitary function scores increased from 2·19 ± 0·83 to 3·31 ± 0·74, P < 0·001). At the last follow-up, children with 3rd VF tumours had more prevalent weight gain (median body mass index: 23·1 kg/m(2) in group B vs 19·7 kg/m(2) in group A, P < 0·001) and increased hypothalamic dysfunction (average hypothalamic status scores: 2·04 ± 0·97 in group B vs 1·29 ± 0·57 in group A, P < 0·001). Children with 3rd VF tumours had a significantly lower probability of recurrence-free survival than those with sellar tumours (at 5 years: 74%vs 49%, respectively; at 10 years: 66%vs 32%, respectively; P = 0·02).
  
  
  CONCLUSIONS
  Substantial differences in the outcome of childhood CP with different tumour growth patterns and locations were found, which suggested that diverse therapeutic considerations, especially endocrinological substitution, might be emphasized.
authors.affiliation: Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China. qisongtao1@hotmail.com
authors.forename: Songtao
authors.initials: S
authors.lastname: Qi
authors.forename: Jun
authors.initials: J
authors.lastname: Pan
authors.forename: Yuntao
authors.initials: Y
authors.lastname: Lu
authors.forename: Fang
authors.initials: F
authors.lastname: Gao
authors.forename: Ying
authors.initials: Y
authors.lastname: Cao
authors.forename: Junxiang
authors.initials: J
authors.lastname: Peng
authors.forename: Xi'an
authors.initials: X
authors.lastname: Zhang
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000172:deficiency; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000473:pathology* / Q000601:surgery; D005260:Female; D013006:Growth Hormone / Q000172:deficiency; D006801:Humans; D008297:Male; D010911:Pituitary Neoplasms / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D012741:Sexual Maturation; D013972:Thyrotropin / Q000172:deficiency; D016896:Treatment Outcome
chemical_list: D000324:Adrenocorticotropic Hormone; D013972:Thyrotropin; D013006:Growth Hormone