Neurosurg Focus. 2026 Jun 1;60(6):E3. doi: 10.3171/2026.2.FOCUS251085.
ABSTRACT
OBJECTIVE: The aim of this study was to assess whether endonasal endoscopic gross-total resection (GTR) of pediatric craniopharyngioma invading the hypothalamus is associated with increased morbidity compared with subtotal resection (STR).
METHODS: Medical records were reviewed for all pediatric patients (age ≤ 21 years) with craniopharyngioma removed via an endonasal endoscopic approach (EEA) between 2006 and 2024. The Sainte-Rose hypothalamic involvement score (HIS) was used to quantify hypothalamic invasion and to assess its correlation with outcome.
RESULTS: Overall, 23 patients (14 male, mean age 11.2 years) met inclusion criteria, with a mean follow-up of 5.6 years. Five, 9, and 9 patients had an HIS of 0, 1, and 2, respectively. Eleven patients underwent GTR, for which the HIS was 0 (n = 3), 1 (n = 4), and 2 (n = 4). GTR and HIS were not associated with new panhypopituitarism, postoperative diabetes insipidus, visual decline, delayed return to school, or decreased academic performance. Preoperative HIS was not significantly associated with BMI increase (HIS 0 [+13.17%], HIS 1 [+23.29%], and HIS 2 [+40.13%], p = 0.36), and neither was extent of resection (GTR [+6.30] and STR [+6.24]). Tumors recurred in 1 of 11 patients (9%) with GTR and 3 of 12 (25%) with STR, without a statistically significant difference.
CONCLUSIONS: In this small series of pediatric patients with craniopharyngioma removed with EEA, GTR was not associated with increased BMI or increased morbidity. There was an increase in BMI that was larger in higher preoperative HIS cases, indicating that morbidity might arise from tumor infiltration into the hypothalamus and not due to the aggressiveness of the surgery. The surgical strategy for treating pediatric craniopharyngioma might need to be reconsidered in the endoscopic era.
PMID:42224721 | DOI:10.3171/2026.2.FOCUS251085
