Pediatric Endocrinology Gynecology and Diabetology Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, 75015 Paris, France.
J Clin Endocrinol Metab. 2013 Jun;98(6):2376-82. doi: 10.1210/jc.2012-3928. Epub 2013 Apr 30.
Craniopharyngioma is a brain tumor whose high local recurrence rate has for a long time led to a preference for extensive surgery. Limited surgery minimizing hypothalamic damage may decrease the severe obesity rate at the expense of the need for radiotherapy to complete the treatment.
We compared weight gain and local recurrence rates after extensive resection surgery (ERS) and hypothalamus-sparing surgery (HSS).
Our observational study compared a historical cohort managed with ERS between 1985 and 2002 to a prospective cohort managed with HSS between 2002 and 2010.
The patients were treated in a pediatric teaching hospital in Paris, France.
Thirty-seven boys and 23 girls were managed with ERS (median age, 8 years); 38 boys and 27 girls were managed with HSS (median age, 9.3 years).
Data were collected before and 6 months to 7 years after surgery. Body mass index (BMI) Z-score was used to assess obesity and the number of surgical procedures to assess local recurrence rate.
Mean BMI Z-score before surgery was comparable in the 2 cohorts (0.756 after ERS vs 0.747 after HSS; P = .528). At any time after surgery, mean BMI Z-score was significantly lower after HSS (eg, 1.889 SD vs 2.915 SD, P = .004 at 1 year). At last follow-up, the HSS cohort had a significantly lower prevalence of severe obesity (28% vs 54%, P < .05) and higher prevalence of normal BMI (38% vs 17%, P < .01). Mean number of surgical procedures was not significantly different in the 2 cohorts.
Hypothalamus-sparing surgery decreases the occurrence of severe obesity without increasing the local recurrence rate.
颅咽管瘤是一种脑肿瘤，其局部高复发率长期以来导致人们倾向于进行广泛的手术。最大限度地减少下丘脑损伤的有限手术可能会降低严重肥胖的发生率，但需要放射治疗来完成治疗。
我们比较了广泛切除术（ERS）和下丘脑保留术（HSS）后的体重增加和局部复发率。
我们的观察性研究比较了 1985 年至 2002 年期间接受 ERS 治疗的历史队列和 2002 年至 2010 年期间接受 HSS 治疗的前瞻性队列。
患者在法国巴黎的一家儿科教学医院接受治疗。
37 名男孩和 23 名女孩接受 ERS 治疗（中位年龄 8 岁）；38 名男孩和 27 名女孩接受 HSS 治疗（中位年龄 9.3 岁）。
数据在手术前和手术后 6 个月至 7 年内收集。体重指数（BMI）Z 评分用于评估肥胖，手术次数用于评估局部复发率。
2 个队列的术前平均 BMI Z 评分相当（ERS 后为 0.756，HSS 后为 0.747；P =.528）。手术后任何时候，HSS 后的平均 BMI Z 评分均显著较低（例如，1.889 SD 对 2.915 SD，P =.004，1 年）。在最后一次随访时，HSS 组严重肥胖的患病率明显较低（28%对 54%，P <.05），正常 BMI 的患病率明显较高（38%对 17%，P <.01）。2 个队列的平均手术次数无显著差异。
下丘脑保留术可降低严重肥胖的发生率，而不会增加局部复发率。
