Brain white matter lesions are associated with reduced hypothalamic volume and cranial radiotherapy in childhood‐onset craniopharyngioma

Fjalldal, Sigridur; Rylander, Lars; Westen, Danielle van; Holmer, Helene; Follin, Cecilia; Gabery, Sanaz; Petersén, Åsa; Erfurth, Eva Marie

doi:10.1111/cen.14307

Cited by 3 publications

(2 citation statements)

References 35 publications

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“…Grading according to Pascual 9 and Saint Rose 10 revealed that the posterior HT on MRI was severely affected and remained displaced during follow up. In addition, after seven years of follow up the volume of the HT was 1/10 of normal (normal 775-941 mm 3 ) 24,7 . A HT volume of 83 mm 3 is in the range where previously studied CPs all suffered from HO 7 .…”

Section: Discussionmentioning

confidence: 91%

Hypothalamic Inflammation and Hypothalamic Obesity: Case Report and Mini-Review

Fjalldal¹,

Stenberg²,

Gabery³

et al. 2022

j Endocrinol sci

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Context: Autoimmune hypothalamitis (AHT) is extremely rare and appears on the Magnetic resonance Imaging (MRI) as a predominant suprasellar mass. There are only a few case reports of AHT in the literature and none was presented together with hypothalamic obesity (HO). Methods of prediction of hypothalamus (HT) damage are included as the pathogenesis of HO. Case description: A 19-year-old female was operated with a transcranial operation due to a large suprasellar mass with symptoms of visual deficiencies and headache. The diagnosis of AHT was confirmed in specimen of lymphocyte-dominated infiltration with plasma cells, neutrophils and fibrocytes. The operation reduced the AHT mass and a further reduction was accomplished by long-term oral Prednisone. Directly after operation she suffered from hypothalamic obesity which worsened after the introduction of Prednisone treatment. During Prednisone treatment a reduction in the inflammation mass and improvement of vision was recorded. She was treated with glucagon-like peptide 1 receptor agonist and Metformin as treatment for her diabetes mellitus type II and with supplementations of her pituitary insufficiencies. The patient exhibits dramatic weight reduction while on a strict caloric diet at two follow-up occasions. However, this effect was reversed once the patient had stopped the calorie restricted diet. Conclusion: The coexistence of AHT and HO is extremely difficult to treat as the former involves Prednisone treatment. Pharmacological intervention of HO has had limited effect on weight, but extreme diet was successful, however with short endurance.

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Section: Discussionmentioning

confidence: 91%

Hypothalamic Inflammation and Hypothalamic Obesity: Case Report and Mini-Review

Fjalldal¹,

Stenberg²,

Gabery³

et al. 2022

j Endocrinol sci

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“…In addition, there has been a rapid growth in application of machine learning (ML) algorithms and automated methods to improve the efficiency collecting volumetric data from lesions on brain MRIs in recent years. [25][26][27] While the sella remains a complex area for automated methods to capture, recent data show that it is feasible, accurately maps tumor volume similarly to manual segmentation (P = .31), and is more accurate than traditional estimates that are known to overestimate volume (P < .01). 28 These methods could soon become incorporated into routine practice and may return similar results as our analysis, which also uses the gold standard of manual segmentation.…”

Section: Discussionmentioning

confidence: 99%

The Knosp Criteria Revisited: 3-Dimensional Volumetric Analysis as a Predictive Tool for Extent of Resection in Complex Endoscopic Pituitary Surgery

et al. 2022

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BACKGROUND: The Knosp criteria have been the historical standard for predicting cavernous sinus invasion, and therefore extent of surgical resection, of pituitary macroadenomas. Few studies have sought to reappraise the utility of this tool after recent advances in visualization and modeling of tumors in complex endoscopic surgery. OBJECTIVE: To evaluate our proposed alternative method, using 3-dimensional (3D) volumetric imaging, and whether it can better predict extent of resection in nonfunctional pituitary adenomas. METHODS: Patients who underwent endoscopic transsphenoidal resection of pituitary macroadenomas at our institution were reviewed. Information was collected on neurological, endocrine, and visual function. Volumetric segmentation was performed using 3D Slicer software. Relationship of tumor volume, clinical features, and Knosp grade on extent of resection was examined. RESULTS: One hundred forty patients were identified who had transsphenoidal resection of nonfunctional pituitary adenomas. Macroadenomas had a median volume of 6 cm 3 (IQR 3.4-8.7), and 17% had a unilateral Knosp grade of at least 3B. On multiple logistic regression, only smaller log-transformed preoperative tumor volume was independently associated with increased odds of gross total resection (GTR; odds ratio: 0.27, 95% CI: 0.07-0.89, P < .05) when controlling for tumor proliferative status, age, and sex (area under the curve 0.67). The Knosp criteria did not independently predict GTR in this cohort (P > .05, area under the curve 0.46). CONCLUSION: Increasing use of volumetric 3D imaging may better anticipate extent of resection compared with the Knosp grade metric and may have a greater positive predictive value for GTR. More research is needed to validate these findings and implement them using automated methods.

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