Postoperative BMI Outcomes in Craniopharyngioma are Associated with Hypothalamic Involvement in Children but not Adults: A Single Institution Endoscopic Endonasal Cohort.

Abstract

More extensive resection of craniopharyngioma may be associated with greater postoperative weight gain, whereas hypothalamus-sparing approaches may reduce this risk without compromising tumor control. We compared oncologic and body mass index (BMI) outcomes across management strategies in adult and pediatric patients. We retrospectively reviewed 48 endoscopic endonasal craniopharyngioma cases (33 adults, 15 children; 2007-2024). Patients were categorized into three management groups: gross-total resection (GTR; 100% radiographic removal), incomplete resection followed by adjuvant radiation, and incomplete resection without radiation. Primary outcomes included BMI change using age-appropriate metrics. At most recent follow-up, median percent ΔBMI increased by 9% in adults (p = 0.01) and 51% in children (p = 0.0001). In adults, greater extent of resection was associated with improved tumor control, with no recurrence after GTR (0/22) compared with 14% (1/7) and 75% (3/4) following incomplete management (p < 0.001), without differences in BMI outcomes across groups. In pediatric patients, management strategy was not associated with oncologic, visual, or BMI outcomes, although interpretation was limited by small subgroup sizes. However, greater hypothalamic involvement was associated with larger long-term BMI increases, with median percent ΔBMI of 31% in Puget 1 versus 56% in Puget 2 patients (p = 0.045). In adults, GTR was associated with improved progression-/recurrence-free survival without worsening BMI trajectories, although follow-up differed among management groups. In pediatric patients, BMI increased across management strategies, suggesting that after contextualizing pediatric growth using height/weight trajectories, no differences in postoperative BMI trajectories were detected between management strategies.