Weight Profile in Children Following Endoscopic Endonasal Approach to Craniopharyngioma

Despite the histologically benign nature of craniopharyngiomas, their proximity to critical structures can cause them to behave as neurologically destructive tumors in both adults and children. The majority of pediatric craniopharyngiomas are treated with a transcranial approach, with visual loss, endocrine dysfunction, and obesity commonly reported following resection. With increasing use of the endoscopic endonasal approach (EEA) in the adult craniopharyngioma population, this method is now employed to treat children. We examined our pediatric cohort with particular emphasis on weight profiles before and after surgery.

From July 2007 to present, 14 children underwent resection of their histologically confirmed craniopharyngioma via EEA, with 10 children having this procedure as initial treatment (71.4%). Children presented with headache (n = 9, 64.3%), visual complaints (n = 5, 35.7%), pituitary dysfunction (n = 4, 28.5%), and an incidental finding (n = 1, 7%). Three children had diabetes insipidus on presentation (21.4%). Preoperative imaging revealed all tumors to be suprasellar, with sellar (n = 7, 50%), third ventricular (n = 7, 50%), and retroclival (n = 4, 28.5%) involvement. Preoperative tumor volume ranged from 1.49 to 45.10 cm³ (mean, 11.85 cm³). Mean length of stay was 16.5 days. All children underwent nasal septal flap reconstruction, 11 (78.6%) had lumbar drainage used until postoperative day 5, and 2 children had placement of EVD intraoperatively. All children had postoperative imaging with MRI, and extent of resection was classified as gross total resection (GTR, n = 8) and near total resection (n = 6). Two children underwent repeat EEA for recurrence; 1 required postoperative shunting, and 2 underwent adjuvant stereotactic radiosurgery. There were no deaths. Complications included CSF leak (n = 1), subdural hematoma following EVD removal (n = 1), and intraparenchymal hematoma with intraventricular extension and resultant hydrocephalus (n = 1). Seven children had preoperative pituitary dysfunction to some extent (3 of the 4 children who underwent EEA for secondary treatment), and all children required some level of postoperative endocrine supplementation. Visual outcomes showed no new visual deficits and improvement in preoperative deficits on formal ophthalmological evaluation in children with preoperative deficit.

Based on BMI-for-age calculations, no child experienced new-onset obesity following surgery (0%). Five children were obese preoperatively (BMI > 95 percentile) and remained as such postoperatively, three of these had prior treatment with open craniotomy. Two children were overweight (BMI 85 to 95 percentile) and remained as such postoperatively. All these aforementioned children followed the same trend on their growth chart, suggesting there was not a change in their overall weight profile following EEA. One child was obese preoperatively but actually lost weight postoperatively and was no longer obese. Six children had normal BMI-for-age preoperatively and did not experience significant weight gain.

EEA is a safe and effective surgical option for pediatric craniopharyngioma. In particular, it allows for visualization of hypothalamic structures and may help avoid postoperative central obesity.