Postoperative Endocrinopathy Incidence following Craniopharyngioma Resection

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Introduction: Postoperative endocrinopathy after surgical resection of craniopharyngioma can be expected given the tumor’s proximity to the hypothalamus and pituitary gland. While surgical planning for these lesions depends on tumor characteristics, the preference of gross total resection (GTR) or subtotal resection (STR) followed by adjuvant radiotherapy (XRT) remains controversial in consideration of recurrence-free survival and increased postoperative comorbidities, namely endocrinopathy. Furthermore, the incidence of endocrinopathy following pituitary stalk preservation or sacrifice is still unclear. We aim to compare the impact of GTR versus STR for craniopharyngioma resection on long-term post-operative endocrinopathy. Methods: A retrospective chart review of patients at a single tertiary medical center was performed. Inclusion criteria for the study comprised adult patients who underwent primary resection of craniopharyngioma; patients presenting for revision surgery were excluded. Patients were stratified into GTR or STR+XRT cohorts, and prescription of steroid medication, desmopressin, thyroid supplementation, and gonadocorticoid supplementation before and after surgery was documented. A Cox-proportional hazards model was used to compare endocrinopathy rates between the two cohorts at 30-day, 6-month, 1-year, and 2-year time points. Results: A total of 27 and 23 patients underwent GTR and STR+XRT for craniopharyngioma, respectively. Patients undergoing GTR had a higher incidence of steroid supplementation ( p = 0.036) and DDAVP use ( p = 0.059) 30 days after surgery, with continued trends for steroid ( p = 0.014) and DDAVP use ( p = 0.077) at 6 months. Desmopressin supplementation within the GTR cohort became significantly higher 1 year after surgery ( p = 0.048) compared with the STR+XRT cohort, while steroid use became insignificant ( p = 0.088). At 2 years, desmopressin use remained significantly higher in the GTR cohort ( p = 0.019), while steroid use became higher in the STR+XRT cohort ( p = 0.254). Conclusion: This is the first study comparing long-term post-operative endocrinopathy following GTR versus STR of craniopharyngioma. Patients undergoing GTR for craniopharyngioma had a significantly higher prevalence of glucocorticoid deficiency within 6 months of surgery, with insignificant prevalence afterward. Antidiuretic hormone deficiency became significantly higher in the GTR cohort 1 year after surgery. Publication History Article published online: 07 February 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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