title: Magnetic resonance imaging as predictor of functional outcome in craniopharyngiomas.
abstract: Quality of life of craniopharyngioma patients can be severely impaired by derangement of hypothalamic function. A classification, taking into account preoperative hypothalamic damage, evaluated by magnetic resonance imaging (MRI), and correlating it with postoperative weight change is still missing in the literature. The aim of our study is to identify objective radiological criteria as preoperative prognostic factors for hypothalamic damage. Pre- and post-operative MRI and clinical data of 47 patients, treated at our Institution for craniopharyngioma, were retrospectively analyzed, based on radiological variables, identified as prognostic factor for hypothalamic involvement. Main factors associated with postoperative obesity were hypothalamic hyperintensity in T2-weighted/FLAIR imaging (p < 0.033), mammillary body involvement according to Müller classification (p < 0.020), unidentifiable pituitary stalk (p < 0.001), dislocated chiasm (p < 0.038), either not visible infundibular recess (p < 0.019) or unrecognizable supra-optic recess (p < 0.004), and retrochiasmatic tumor extension (p < 0.019). Accordingly, postoperative hypothalamic syndrome was associated with peritumoral edema in T2-weighted/FLAIR images (p < 0.003), unidentifiable hypothalamus (p < 0.024), hypothalamic compression (p < 0.006), fornix displacement (p < 0.032), and unrecognizable supra-optic recess (p < 0.031). Ultimately, variables identified as predictive factors of postoperative hypothalamic syndrome were the degree of hypothalamic involvement according to the classification described by Sainte-Rose and Puget (p < 0.002; grade 0 vs 2 p < 0.001), Van Gompel (p < 0.002; grade 0 vs 1, p < 0.027; and grade 0 vs 2, p < 0.002), and Muller (p < 0.006; grade 0 vs 1, p < 0.05; and grade 0 vs 2, p < 0.004). The identification of these predictive factors will help to define and score the preoperative hypothalamic involvement in craniopharyngioma patients.
authors.affiliation: Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Mortini
authors.affiliation: Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy. gagliardi.filippo@hsr.it.
authors.forename: Filippo
authors.initials: F
authors.lastname: Gagliardi
authors.affiliation: Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Bailo
authors.affiliation: Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Alfio
authors.initials: A
authors.lastname: Spina
authors.affiliation: Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Parlangeli
authors.affiliation: Department of Neuroradiology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Falini
authors.affiliation: Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Losa
mesh_terms: D000328:Adult; D002648:Child; D003397:Craniopharyngioma / Q000175:diagnosis* / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D007031:Hypothalamus / Q000473:pathology / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D010911:Pituitary Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D011237:Predictive Value of Tests; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Clinical outcome; Craniopharyngioma; Hypothalamus; MRI