title: Childhood craniopharyngioma: hypothalamus-sparing surgery decreases the risk of obesity.
abstract: BACKGROUND
  Craniopharyngioma is a brain tumor whose high local recurrence rate has for a long time led to a preference for extensive surgery. Limited surgery minimizing hypothalamic damage may decrease the severe obesity rate at the expense of the need for radiotherapy to complete the treatment.
  
  
  OBJECTIVE
  We compared weight gain and local recurrence rates after extensive resection surgery (ERS) and hypothalamus-sparing surgery (HSS).
  
  
  METHODS
  Our observational study compared a historical cohort managed with ERS between 1985 and 2002 to a prospective cohort managed with HSS between 2002 and 2010.
  
  
  METHODS
  The patients were treated in a pediatric teaching hospital in Paris, France.
  
  
  METHODS
  Thirty-seven boys and 23 girls were managed with ERS (median age, 8 years); 38 boys and 27 girls were managed with HSS (median age, 9.3 years).
  
  
  METHODS
  Data were collected before and 6 months to 7 years after surgery. Body mass index (BMI) Z-score was used to assess obesity and the number of surgical procedures to assess local recurrence rate.
  
  
  RESULTS
  Mean BMI Z-score before surgery was comparable in the 2 cohorts (0.756 after ERS vs 0.747 after HSS; P = .528). At any time after surgery, mean BMI Z-score was significantly lower after HSS (eg, 1.889 SD vs 2.915 SD, P = .004 at 1 year). At last follow-up, the HSS cohort had a significantly lower prevalence of severe obesity (28% vs 54%, P < .05) and higher prevalence of normal BMI (38% vs 17%, P < .01). Mean number of surgical procedures was not significantly different in the 2 cohorts.
  
  
  CONCLUSIONS
  Hypothalamus-sparing surgery decreases the occurrence of severe obesity without increasing the local recurrence rate.
authors: Pediatric Endocrinology Gynecology and Diabetology Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, 75015 Paris, France.
authors: E
authors: E
authors: Elowe-Gruau
authors: J
authors: J
authors: Beltrand
authors: R
authors: R
authors: Brauner
authors: G
authors: G
authors: Pinto
authors: D
authors: D
authors: Samara-Boustani
authors: C
authors: C
authors: Thalassinos
authors: K
authors: K
authors: Busiah
authors: K
authors: K
authors: Laborde
authors: N
authors: N
authors: Boddaert
authors: M
authors: M
authors: Zerah
authors: C
authors: C
authors: Alapetite
authors: J
authors: J
authors: Grill
authors: P
authors: P
authors: Touraine
authors: C
authors: C
authors: Sainte-Rose
authors: M
authors: M
authors: Polak
authors: S
authors: S
authors: Puget
mesh_terms: D015992:Body Mass Index; D002648:Child; D003397:Craniopharyngioma / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007031:Hypothalamus / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control*; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D012306:Risk