Magnetic resonance imaging-graded hypothalamic compression in surgically treated adult craniopharyngiomas determining postoperative obesity

Jamie Van Gompel, Todd B. Nippoldt, Dominique M. Higgins, Fredric B. Meyer

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Object. Obesity as a consequence of management of pediatric craniopharyngioma is a well-described phenomenon related to the degree of hypothalamic involvement. However, weight change and obesity have not been analyzed in adult patients. Therefore, the purpose of this study was 1) to evaluate the pattern of postoperative weight gain related to preoperative body mass index (BMI), 2) determine if postoperative weight gain is an issue in adult patients, and 3) develop an objective MR imaging grading system to predict risk of postoperative weight gain and obesity in adults treated for craniopharyngioma. Methods. The authors retrospectively screened 296 patients with known craniopharyngioma for the following inclusion criteria: pathologically confirmed craniopharyngioma, index surgery at the authors' institution, and operative weight and height recorded with at least 3 months of follow-up including body weight measurement. Patients aged 18 years or younger were excluded, yielding 28 cases for analysis. Cases of craniopharyngiomas were compared with age-and sex-matched controls (pituitary adenoma patients) to evaluate the pattern and significance of perioperative weight changes. Results. Mean age was 46 ± 17 years at surgery, and 64% of the patients were male. Complete resection was achieved in 71% of cases. There was no correlation of preoperative BMI and postoperative weight gain testing in a linear model. Sixty-one percent and 46% of patients had postoperative weight gains greater than 4 and 9%, respectively. Comparing craniopharyngioma patients (cases) to age-and sex-matched controls, the preoperative BMIs were similar (p = 0.93) between cases (mean 28.9 [95% CI 30.9-26.9]) and controls (mean 29.3 [95% CI 31.9-26.7]). However, there was a trend to a greater mean postoperative weight change (percentage) in cases (10.1%) than in controls (5.6%) (p = 0.24). Hypothalamic T2 signal change and irregular contrast enhancement correlated and predicted higher-grade hypothalamic involvement. Furthermore, they can be used to objectively grade hypothalamic involvement as the authors propose. Progressive hypothalamic involvement correlated with larger postoperative weight gains (p = 0.022); however, hypothalamic involvement did not correlate with preoperative BMI (p = 0.5). Conclusions. Postoperative weight gain in adult patients undergoing surgery for craniopharyngioma is a significant problem and correlates with hypothalamic involvement, as it does in pediatric patients. Finally, objective MR imaging criteria can be used to predict risk of postoperative weight gain and aid in grading of hypothalamic involvement.

Original languageEnglish (US)
JournalNeurosurgical Focus
Volume28
Issue number4
DOIs
StatePublished - Apr 2010

Fingerprint

Craniopharyngioma
Obesity
Magnetic Resonance Imaging
Weight Gain
Weights and Measures
Body Mass Index
Pediatrics
Pituitary Neoplasms
Linear Models
Body Weight

Keywords

  • Body mass index
  • Craniopharyngioma
  • Hypothalamus
  • Obesity
  • Weight gain

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Magnetic resonance imaging-graded hypothalamic compression in surgically treated adult craniopharyngiomas determining postoperative obesity. / Van Gompel, Jamie; Nippoldt, Todd B.; Higgins, Dominique M.; Meyer, Fredric B.

In: Neurosurgical Focus, Vol. 28, No. 4, 04.2010.

Research output: Contribution to journalArticle

@article{4cdf7bb61fc14127b3af538c6fab5946,
title = "Magnetic resonance imaging-graded hypothalamic compression in surgically treated adult craniopharyngiomas determining postoperative obesity",
abstract = "Object. Obesity as a consequence of management of pediatric craniopharyngioma is a well-described phenomenon related to the degree of hypothalamic involvement. However, weight change and obesity have not been analyzed in adult patients. Therefore, the purpose of this study was 1) to evaluate the pattern of postoperative weight gain related to preoperative body mass index (BMI), 2) determine if postoperative weight gain is an issue in adult patients, and 3) develop an objective MR imaging grading system to predict risk of postoperative weight gain and obesity in adults treated for craniopharyngioma. Methods. The authors retrospectively screened 296 patients with known craniopharyngioma for the following inclusion criteria: pathologically confirmed craniopharyngioma, index surgery at the authors' institution, and operative weight and height recorded with at least 3 months of follow-up including body weight measurement. Patients aged 18 years or younger were excluded, yielding 28 cases for analysis. Cases of craniopharyngiomas were compared with age-and sex-matched controls (pituitary adenoma patients) to evaluate the pattern and significance of perioperative weight changes. Results. Mean age was 46 ± 17 years at surgery, and 64{\%} of the patients were male. Complete resection was achieved in 71{\%} of cases. There was no correlation of preoperative BMI and postoperative weight gain testing in a linear model. Sixty-one percent and 46{\%} of patients had postoperative weight gains greater than 4 and 9{\%}, respectively. Comparing craniopharyngioma patients (cases) to age-and sex-matched controls, the preoperative BMIs were similar (p = 0.93) between cases (mean 28.9 [95{\%} CI 30.9-26.9]) and controls (mean 29.3 [95{\%} CI 31.9-26.7]). However, there was a trend to a greater mean postoperative weight change (percentage) in cases (10.1{\%}) than in controls (5.6{\%}) (p = 0.24). Hypothalamic T2 signal change and irregular contrast enhancement correlated and predicted higher-grade hypothalamic involvement. Furthermore, they can be used to objectively grade hypothalamic involvement as the authors propose. Progressive hypothalamic involvement correlated with larger postoperative weight gains (p = 0.022); however, hypothalamic involvement did not correlate with preoperative BMI (p = 0.5). Conclusions. Postoperative weight gain in adult patients undergoing surgery for craniopharyngioma is a significant problem and correlates with hypothalamic involvement, as it does in pediatric patients. Finally, objective MR imaging criteria can be used to predict risk of postoperative weight gain and aid in grading of hypothalamic involvement.",
keywords = "Body mass index, Craniopharyngioma, Hypothalamus, Obesity, Weight gain",
author = "{Van Gompel}, Jamie and Nippoldt, {Todd B.} and Higgins, {Dominique M.} and Meyer, {Fredric B.}",
year = "2010",
month = "4",
doi = "10.3171/2010.1.FOCUS09303",
language = "English (US)",
volume = "28",
journal = "Neurosurgical Focus",
issn = "1092-0684",
publisher = "American Association of Neurological Surgeons",
number = "4",

}

TY - JOUR

T1 - Magnetic resonance imaging-graded hypothalamic compression in surgically treated adult craniopharyngiomas determining postoperative obesity

AU - Van Gompel, Jamie

AU - Nippoldt, Todd B.

AU - Higgins, Dominique M.

AU - Meyer, Fredric B.

PY - 2010/4

Y1 - 2010/4

N2 - Object. Obesity as a consequence of management of pediatric craniopharyngioma is a well-described phenomenon related to the degree of hypothalamic involvement. However, weight change and obesity have not been analyzed in adult patients. Therefore, the purpose of this study was 1) to evaluate the pattern of postoperative weight gain related to preoperative body mass index (BMI), 2) determine if postoperative weight gain is an issue in adult patients, and 3) develop an objective MR imaging grading system to predict risk of postoperative weight gain and obesity in adults treated for craniopharyngioma. Methods. The authors retrospectively screened 296 patients with known craniopharyngioma for the following inclusion criteria: pathologically confirmed craniopharyngioma, index surgery at the authors' institution, and operative weight and height recorded with at least 3 months of follow-up including body weight measurement. Patients aged 18 years or younger were excluded, yielding 28 cases for analysis. Cases of craniopharyngiomas were compared with age-and sex-matched controls (pituitary adenoma patients) to evaluate the pattern and significance of perioperative weight changes. Results. Mean age was 46 ± 17 years at surgery, and 64% of the patients were male. Complete resection was achieved in 71% of cases. There was no correlation of preoperative BMI and postoperative weight gain testing in a linear model. Sixty-one percent and 46% of patients had postoperative weight gains greater than 4 and 9%, respectively. Comparing craniopharyngioma patients (cases) to age-and sex-matched controls, the preoperative BMIs were similar (p = 0.93) between cases (mean 28.9 [95% CI 30.9-26.9]) and controls (mean 29.3 [95% CI 31.9-26.7]). However, there was a trend to a greater mean postoperative weight change (percentage) in cases (10.1%) than in controls (5.6%) (p = 0.24). Hypothalamic T2 signal change and irregular contrast enhancement correlated and predicted higher-grade hypothalamic involvement. Furthermore, they can be used to objectively grade hypothalamic involvement as the authors propose. Progressive hypothalamic involvement correlated with larger postoperative weight gains (p = 0.022); however, hypothalamic involvement did not correlate with preoperative BMI (p = 0.5). Conclusions. Postoperative weight gain in adult patients undergoing surgery for craniopharyngioma is a significant problem and correlates with hypothalamic involvement, as it does in pediatric patients. Finally, objective MR imaging criteria can be used to predict risk of postoperative weight gain and aid in grading of hypothalamic involvement.

AB - Object. Obesity as a consequence of management of pediatric craniopharyngioma is a well-described phenomenon related to the degree of hypothalamic involvement. However, weight change and obesity have not been analyzed in adult patients. Therefore, the purpose of this study was 1) to evaluate the pattern of postoperative weight gain related to preoperative body mass index (BMI), 2) determine if postoperative weight gain is an issue in adult patients, and 3) develop an objective MR imaging grading system to predict risk of postoperative weight gain and obesity in adults treated for craniopharyngioma. Methods. The authors retrospectively screened 296 patients with known craniopharyngioma for the following inclusion criteria: pathologically confirmed craniopharyngioma, index surgery at the authors' institution, and operative weight and height recorded with at least 3 months of follow-up including body weight measurement. Patients aged 18 years or younger were excluded, yielding 28 cases for analysis. Cases of craniopharyngiomas were compared with age-and sex-matched controls (pituitary adenoma patients) to evaluate the pattern and significance of perioperative weight changes. Results. Mean age was 46 ± 17 years at surgery, and 64% of the patients were male. Complete resection was achieved in 71% of cases. There was no correlation of preoperative BMI and postoperative weight gain testing in a linear model. Sixty-one percent and 46% of patients had postoperative weight gains greater than 4 and 9%, respectively. Comparing craniopharyngioma patients (cases) to age-and sex-matched controls, the preoperative BMIs were similar (p = 0.93) between cases (mean 28.9 [95% CI 30.9-26.9]) and controls (mean 29.3 [95% CI 31.9-26.7]). However, there was a trend to a greater mean postoperative weight change (percentage) in cases (10.1%) than in controls (5.6%) (p = 0.24). Hypothalamic T2 signal change and irregular contrast enhancement correlated and predicted higher-grade hypothalamic involvement. Furthermore, they can be used to objectively grade hypothalamic involvement as the authors propose. Progressive hypothalamic involvement correlated with larger postoperative weight gains (p = 0.022); however, hypothalamic involvement did not correlate with preoperative BMI (p = 0.5). Conclusions. Postoperative weight gain in adult patients undergoing surgery for craniopharyngioma is a significant problem and correlates with hypothalamic involvement, as it does in pediatric patients. Finally, objective MR imaging criteria can be used to predict risk of postoperative weight gain and aid in grading of hypothalamic involvement.

KW - Body mass index

KW - Craniopharyngioma

KW - Hypothalamus

KW - Obesity

KW - Weight gain

UR - http://www.scopus.com/inward/record.url?scp=77953676811&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77953676811&partnerID=8YFLogxK

U2 - 10.3171/2010.1.FOCUS09303

DO - 10.3171/2010.1.FOCUS09303

M3 - Article

C2 - 20367360

AN - SCOPUS:77953676811

VL - 28

JO - Neurosurgical Focus

JF - Neurosurgical Focus

SN - 1092-0684

IS - 4

ER -