Pituitary · 2025
Postoperative weight gain following endoscopic endonasal surgery for craniopharyngiomas in children and adults: A retrospective cohort study.
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Hongo Takeshi, Akutsu Hiroyoshi, Morinaga Yusuke, Shibao Shunsuke, Oshida Sotaro, Tsunemi Yasuhiro, Kashiwagi Takashi, Nakayama Tsuguhisa, Tomaru Takuya, Otaka Tomohiro, Kino Hiroyoshi, Hara Takuma, Tanaka Shuho, Yamamoto Tetsuya
Аннотация
PURPOSE: Postoperative weight gain following endoscopic endonasal surgery (EES) for craniopharyngiomas remains a challenging complication. Thus, in this study, we aimed to identify risk factors for new or worsened obesity following EES and to explore age-related patterns of postoperative weight change.
METHODS: We conducted a retrospective cohort study of 72 patients (26 pediatric and 46 adult) who underwent initial EES for craniopharyngioma at two academic centers. We defined obesity based on body mass index (BMI) in adults and the BMI standard deviation score in pediatric patients. The primary outcome was new or worsened obesity at follow-up. Tumor extension and hypothalamic involvement/damage were assessed using standardized classification systems. Multivariate logistic regression was used to identify independent predictors.
RESULTS: New or worsened obesity was observed in 17 patients (23.6%). Retroinfundibular tumor extension (odds ratio [OR]: 9.81; p = 0.002) and postoperative hypothalamic damage (OR: 7.72; p = 0.016) were independently associated with new or worsened obesity. However, surgical factors, including resection and operative complexity, were not significant predictors. Subgroup analyses revealed that a subset of pediatric patients developed early-onset and persistent obesity, whereas adults (particularly young adults) experienced gradual weight gain.
CONCLUSION: Retroinfundibular tumor extension and hypothalamic damage are key risk factors for postoperative obesity following EES, whereas aggressive resection itself does not increase the risk. Pediatric patients may develop obesity early and persistently, whereas adults, particularly young adults, are prone to gradual weight gain. Early diagnosis and strategic treatment for high-risk individuals may improve the prognosis for patients with hypothalamic obesity.
METHODS: We conducted a retrospective cohort study of 72 patients (26 pediatric and 46 adult) who underwent initial EES for craniopharyngioma at two academic centers. We defined obesity based on body mass index (BMI) in adults and the BMI standard deviation score in pediatric patients. The primary outcome was new or worsened obesity at follow-up. Tumor extension and hypothalamic involvement/damage were assessed using standardized classification systems. Multivariate logistic regression was used to identify independent predictors.
RESULTS: New or worsened obesity was observed in 17 patients (23.6%). Retroinfundibular tumor extension (odds ratio [OR]: 9.81; p = 0.002) and postoperative hypothalamic damage (OR: 7.72; p = 0.016) were independently associated with new or worsened obesity. However, surgical factors, including resection and operative complexity, were not significant predictors. Subgroup analyses revealed that a subset of pediatric patients developed early-onset and persistent obesity, whereas adults (particularly young adults) experienced gradual weight gain.
CONCLUSION: Retroinfundibular tumor extension and hypothalamic damage are key risk factors for postoperative obesity following EES, whereas aggressive resection itself does not increase the risk. Pediatric patients may develop obesity early and persistently, whereas adults, particularly young adults, are prone to gradual weight gain. Early diagnosis and strategic treatment for high-risk individuals may improve the prognosis for patients with hypothalamic obesity.