Diagnosis, Background, and Treatment of Hypothalamic Damage in Craniopharyngioma

Abstract

Craniopharyngiomas (CP) are rare brain tumors managed primarily with surgery and radiotherapy. There are 2 phenotypes of CP, i.e., one with a rather good outcome without hypothalamic damage and another with hypothalamic damage. With hypothalamic damage, progressive disease with recurrent operations and additional cranial radiotherapy often result in hypothalamic obesity, an affected psychosocial life, and cognitive dysfunction. The morbidity and mortality are increased for particularly cerebrovascular diseases. Preoperative hypothalamic involvement to predict hypothalamic damage is important for decision making for hypothalamus-sparing surgery. Also a postoperative hypothalamic damage evaluation with the use of hypothalamus volume measurement can predict hypothalamic obesity, which is important for early treatment options. The morbidity of CP includes cognitive dysfunction with attention deficits and impaired episodic memory and processing speed. Again patients with hypothalamic damage are more affected. Treatment options of hypothalamic obesity in the chronic phase are scarce and not convincingly successful. The most optimal situation is to try to hinder or stop the evolution of hypothalamic obesity. Prevention of hypothalamic damage is recommended, with special regard to hypothalamus-sparing therapeutic approaches that respect the integrity of essential nuclei located in both the medial and the posterior hypothalamic areas.

Clinical Analysis of Risk Factors of Postoperative Psychiatric Disorders in Patients With Adult Craniopharyngioma

“…Hypothalamic invasion is considered to be an independent risk factor in our study. The exact mechanism of psychiatric disorder is still unclear; however, hypothalamus injury is a relatively recognized reason ( 21 ). The central position of the hypothalamus around the third ventricle serves as the convergence point of numerous neural pathways connecting different brain areas.…”

“…This diencephalic region hosts the headquarters of the brain circuitry involved in monitoring the continuous changes of the internal medium as well as external conditions to coordinate the appropriate neuroendocrine responses and active behaviors to restore body homeostasis and mental balance. Therefore, any lesion invades into the hypothalamic centers that participate in the integration of emotional and behavioral responses, which would cause potentially structural and functional damage, resulting in the development of numerous psychiatric disorders ( 13 , 21 – 23 ). This mechanism may explain why the rate of psychiatric disorders in the group of patients with hypothalamic invasion was higher than that without hypothalamic invasion (χ 2 = 8.807, p = 0.003) ( Figures 2 – 4 ).…”

Sleep Disorders in Patients With Craniopharyngioma: A Physiopathological and Practical Update

“…The best results in terms of progression-free survival after conservative surgery have been reported in association with post-operative radiotherapy and are similar to those obtained by gross total resection. However, side effects of irradiation are delayed and may include hypothalamic complications ( 9 ). Among modern techniques, proton therapy may take an increasing place in the treatment of residual or recurrent CP because of the dosimetric characteristics of protons and limited off-target toxicity ( 2 , 85 ).…”

“…Hypothalamic damage may severely impair the quality of life (QoL) of patients and has an impact on long-term mortality ( 8 ). The extension and localization of hypothalamic injury due to the tumor itself, neurosurgery, and, in some cases, radiotherapy, contribute to the timing and severity of HS ( 5 , 9 ). The optimal treatment for CP and related complications remains difficult and relies on a multidisciplinary approach, with increasing attention being paid in the last decades to the prevention of hypothalamic damage during surgery ( 2 , 10 ).…”

Adamantinomatous craniopharyngioma as a model to understand paracrine and senescence-induced tumourigenesis

“…This morbidity is due to the tumour's tendency to invade surrounding structures such as the pituitary, hypothalamus and optic chiasm. Consequences of both tumour growth and its treatment include pan-hypopituitarism with multiple neuroendocrine deficiencies, blindness and hypothalamic damage, which usually leads to obesity, subsequent type-2 diabetes and cardiovascular disease [58][59][60]. Furthermore, reduced psychosocial and neurocognitive function are common in survivors, mostly in patients of younger age [58,61].…”