{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:16:35Z","timestamp":1791504995443,"version":"4.3.4"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The optimal extent of resection of craniopharyngiomas to minimize the long-term risks of hypothalamic and endocrine dysfunction (obesity and panhypopituitarism) in children remains uncertain. The purpose of this study was to report long-term outcomes of pediatric patients with craniopharyngioma undergoing surgical treatment and to study rates of endocrinological and hypothalamic dysfunction in association with extent of resection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This retrospective study was performed in a cohort of children who underwent resection for craniopharyngioma at Children\u2019s of Alabama between 1990 and 2020. The primary outcome was hypothalamic dysfunction defined as a 0.5 increase in body mass index (BMI) Z-score and as a BMI &gt; 2 SDs with or without psychiatric disturbances. Univariable analysis was performed using ANOVA, Wilcoxon rank-sum test, Pearson\u2019s chi-square test, and Fisher\u2019s exact test as appropriate. Missing data on the primary outcome were handled via multiple imputations. Relative risks were estimated using a multivariable generalized linear model with a priori variables selected using a modified Poisson regression approach with robust error variance to estimate risk ratios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The cohort includes 39 patients (24 girls and 15 boys; age range 1 month\u201316 years) who underwent resection of craniopharyngioma at the authors\u2019 center between 1990 and 2020. The preoperative goal of treatment was cyst decompression (CD) in 5, subtotal resection (STR) in 13, and gross-total resection (GTR) in 21 patients. The median long-term follow-up after surgery was 8.11 years (average 8.21, range 0.4\u201324.33 years). Univariate analysis demonstrated a statistically significant increase in hypothalamic dysfunction in patients undergoing GTR when compared to those undergoing STR or CD at 1 month postoperatively (p = 0.006) and 6\u201311 months postoperatively (p = 0.010), but with this difference not persisting beyond 1 year. Multivariable analysis showed patients older than 10 years at time of surgery to be the most affected and at highest risk of developing significant hypothalamic dysfunction. There was no significant difference in pituitary or neurological function between the STR\/CD and GTR groups at 12\u201324 months or at most recent follow-up. There was no significant difference in BMI Z-scores between the STR\/CD and GTR groups at 6\u201312 months or at most recent follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Both STR and GTR of craniopharyngioma were associated with significant endocrinological sequelae after 1 year. These potential complications should be discussed with patients and their families, and postoperative protocols should include early nutritional and endocrinological interventions with endocrinologist consultation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2023.5.peds22568","type":"journal-article","created":{"date-parts":[[2023,8,12]],"date-time":"2023-08-12T01:17:41Z","timestamp":1691803061000},"page":"569-575","source":"Crossref","is-referenced-by-count":10,"title":["Does subtotal resection ameliorate hypothalamic morbidity in pediatric craniopharyngioma? A 30-year retrospective cohort study"],"prefix":"10.3171","volume":"32","author":[{"given":"Omer K.","family":"Yousuf","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatrics, University of Alabama, Birmingham;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arsalaan","family":"Salehani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Alabama, Birmingham, Alabama; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathrin","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatrics, University of Alabama, Birmingham;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dagoberto","family":"Estevez-Ordonez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Alabama, Birmingham, Alabama; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casey","family":"Madura","sequence":"additional","affiliation":[{"name":"Section of Pediatric Neurosurgery, Helen DeVos Children\u2019s Hospital, Grand Rapids, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Arynchyna-Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatrics, University of Alabama, Birmingham;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"Johnston","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatrics, University of Alabama, Birmingham;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Curtis J.","family":"Rozzelle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatrics, University of Alabama, Birmingham;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon G.","family":"Rocque","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatrics, University of Alabama, Birmingham;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey P.","family":"Blount","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatrics, University of Alabama, Birmingham;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"J Neurol Surg B Skull Base","first-page":"65","article-title":"Pediatric craniopharyngiomas: a primer for the skull base surgeon","volume":"79","author":"Graffeo CS","year":"2018","unstructured":"Graffeo CS, Perry A, Link MJ, Daniels DJ. Pediatric craniopharyngiomas: a primer for the skull base surgeon. J Neurol Surg B Skull Base. 2018;79(1):65\u201380."},{"issue":"4","key":"b2","series-title":"Int J Radiat Oncol Biol Phys","first-page":"e187","article-title":"Disease control after reduced volume conformal and intensity modulated radiation therapy for childhood craniopharyngioma","volume":"85","author":"Merchant TE","year":"2013","unstructured":"Merchant TE, Kun LE, Hua CH,  Disease control after reduced volume conformal and intensity modulated radiation therapy for childhood craniopharyngioma. Int J Radiat Oncol Biol Phys. 2013;85(4):e187\u2013e192."},{"issue":"6","key":"b3","series-title":"J Neurosurg Pediatr","first-page":"549","article-title":"Therapeutic outcomes of transsphenoidal surgery in pediatric patients with craniopharyngiomas: a single-center study","volume":"21","author":"Yamada S","year":"2018","unstructured":"Yamada S, Fukuhara N, Yamaguchi-Okada M,  Therapeutic outcomes of transsphenoidal surgery in pediatric patients with craniopharyngiomas: a single-center study. J Neurosurg Pediatr. 2018;21(6):549\u2013562."},{"issue":"1","key":"b4","series-title":"Childs Nerv Syst","first-page":"79","article-title":"Giant craniopharyngiomas in children: short- and long-term implications","volume":"32","author":"Yosef L","year":"2016","unstructured":"Yosef L, Ekkehard KM, Shalom M. Giant craniopharyngiomas in children: short- and long-term implications. Childs Nerv Syst. 2016;32(1):79\u201388."},{"issue":"4","key":"b5","series-title":"Neurosurgery","first-page":"631","article-title":"Adult craniopharyngioma: case series, systematic review, and meta-analysis","volume":"83","author":"Dandurand C","year":"2018","unstructured":"Dandurand C, Sepehry AA, Asadi Lari MH, Akagami R, Gooderham P. Adult craniopharyngioma: case series, systematic review, and meta-analysis. Neurosurgery. 2018;83(4):631\u2013641."},{"issue":"1","key":"b6","series-title":"J Neurooncol","first-page":"133","article-title":"The superiority of conservative resection and adjuvant radiation for craniopharyngiomas","volume":"108","author":"Schoenfeld A","year":"2012","unstructured":"Schoenfeld A, Pekmezci M, Barnes MJ,  The superiority of conservative resection and adjuvant radiation for craniopharyngiomas. J Neurooncol. 2012;108(1):133\u2013139."},{"issue":"1","key":"b7","series-title":"Innov Surg Sci","first-page":"25","article-title":"Surgical aspects in craniopharyngioma treatment","volume":"30","author":"Fujio S","year":"2020","unstructured":"Fujio S, Hanada T, Yonenaga M,  Surgical aspects in craniopharyngioma treatment. Innov Surg Sci. 2020;30;6(1):25-33."},{"issue":"7","key":"b8","series-title":"Pediatr Blood Cancer","first-page":"860","article-title":"Predicting behavioral problems in craniopharyngioma survivors after conformal radiation therapy","volume":"52","author":"Dolson EP","year":"2009","unstructured":"Dolson EP, Conklin HM, Li C, Xiong X, Merchant TE. Predicting behavioral problems in craniopharyngioma survivors after conformal radiation therapy. Pediatr Blood Cancer. 2009;52(7):860\u2013864."},{"issue":"3","key":"b9","series-title":"J Neurol Surg B Skull Base","first-page":"227","article-title":"Extent of endoscopic resection for anterior skull base tumors: an MRI-based volumetric analysis","volume":"78","author":"Koszewski IJ","year":"2017","unstructured":"Koszewski IJ, Avey G, Ahmed A, Leonhard L, Hoffman MR, McCulloch TM. Extent of endoscopic resection for anterior skull base tumors: an MRI-based volumetric analysis. J Neurol Surg B Skull Base. 2017;78(3):227\u2013234."},{"issue":"6","key":"b10","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Endoscopic endonasal versus open transcranial resection of craniopharyngiomas: a case-matched single-institution analysis","volume":"41","author":"Moussazadeh N","year":"2016","unstructured":"Moussazadeh N, Prabhu V, Bander ED,  Endoscopic endonasal versus open transcranial resection of craniopharyngiomas: a case-matched single-institution analysis. Neurosurg Focus. 2016;41(6):E7."},{"issue":"2","key":"b11","series-title":"Childs Nerv Syst","first-page":"231","article-title":"A systematic review of the results of surgery and radiotherapy on tumor control for pediatric craniopharyngioma","volume":"29","author":"Clark AJ","year":"2013","unstructured":"Clark AJ, Cage TA, Aranda D,  A systematic review of the results of surgery and radiotherapy on tumor control for pediatric craniopharyngioma. Childs Nerv Syst. 2013;29(2):231\u2013238."},{"issue":"5","key":"b12","series-title":"Surg Neurol","first-page":"482","article-title":"Pituitary function after endonasal surgery for nonadenomatous parasellar tumors: Rathke\u2019s cleft cysts, craniopharyngiomas, and meningiomas","volume":"70","author":"Dusick JR","year":"2008","unstructured":"Dusick JR, Fatemi N, Mattozo C,  Pituitary function after endonasal surgery for nonadenomatous parasellar tumors: Rathke\u2019s cleft cysts, craniopharyngiomas, and meningiomas. Surg Neurol. 2008;70(5):482\u2013491."},{"key":"b13","series-title":"Clin Neurol Neurosurg","first-page":"162","article-title":"Clinical study on microsurgical treatment for craniopharyngioma in a single consecutive institutional series of 335 patients","volume":"167","author":"Guo F","year":"2018","unstructured":"Guo F, Wang G, Suresh V,  Clinical study on microsurgical treatment for craniopharyngioma in a single consecutive institutional series of 335 patients. Clin Neurol Neurosurg. 2018;167:162\u2013172."},{"issue":"5","key":"b14","series-title":"J Korean Neurosurg Soc","first-page":"432","article-title":"Is the complete resection of craniopharyngiomas in adults feasible considering both the oncologic and functional outcomes?","volume":"58","author":"Lee EJ","year":"2015","unstructured":"Lee EJ, Cho YH, Hong SH, Kim JH, Kim CJ. Is the complete resection of craniopharyngiomas in adults feasible considering both the oncologic and functional outcomes?. J Korean Neurosurg Soc. 2015;58(5):432\u2013441."},{"issue":"4","key":"b15","series-title":"J Neurosurg","first-page":"1163","article-title":"Preserve or sacrifice the stalk? Endocrinological outcomes, extent of resection, and recurrence rates following endoscopic endonasal resection of craniopharyngiomas","volume":"131","author":"Ord\u00f3\u00f1ez-Rubiano EG","year":"2019","unstructured":"Ord\u00f3\u00f1ez-Rubiano EG, Forbes JA, Morgenstern PF,  Preserve or sacrifice the stalk? Endocrinological outcomes, extent of resection, and recurrence rates following endoscopic endonasal resection of craniopharyngiomas. 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Acta Neurochir (Wien). 2018;160(7):1425\u20131431."},{"issue":"1","key":"b17","series-title":"J Neurooncol","first-page":"97","article-title":"Neurocognitive functioning in pediatric craniopharyngioma: performance before treatment with proton therapy","volume":"134","author":"Fournier-Goodnight AS","year":"2017","unstructured":"Fournier-Goodnight AS, Ashford JM, Merchant TE,  Neurocognitive functioning in pediatric craniopharyngioma: performance before treatment with proton therapy. J Neurooncol. 2017;134(1):97\u2013105."},{"issue":"3","key":"b18","series-title":"J Neurosurg","first-page":"627","article-title":"Comparative analysis of outcomes following craniotomy and expanded endoscopic endonasal transsphenoidal resection of craniopharyngioma and related tumors: a single-institution study","volume":"124","author":"Jeswani S","year":"2016","unstructured":"Jeswani S, Nu\u00f1o M, Wu A,  Comparative analysis of outcomes following craniotomy and expanded endoscopic endonasal transsphenoidal resection of craniopharyngioma and related tumors: a single-institution study. J Neurosurg. 2016;124(3):627\u2013638."},{"key":"b19","series-title":"World Neurosurg","first-page":"465","article-title":"Clinical outcome after extended endoscopic endonasal resection of craniopharyngiomas: two-institution experience","volume":"103","author":"Park HR","year":"2017","unstructured":"Park HR, Kshettry VR, Farrell CJ,  Clinical outcome after extended endoscopic endonasal resection of craniopharyngiomas: two-institution experience. World Neurosurg. 2017;103:465\u2013474."},{"issue":"9596","key":"b20","series-title":"Lancet","first-page":"1453","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm E","year":"2007","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453\u20131457."},{"issue":"63","key":"b21","series-title":"Natl Health Stat Rep","first-page":"1","article-title":"Construction of LMS parameters for the Centers for Disease Control and Prevention 2000 growth charts","volume":"63","author":"Flegal KM","year":"2013","unstructured":"Flegal KM, Cole TJ. Construction of LMS parameters for the Centers for Disease Control and Prevention 2000 growth charts. Natl Health Stat Rep. 2013;63(63):1\u20133."},{"issue":"4","key":"b22","series-title":"Am J Epidemiol","first-page":"301","article-title":"Model-based estimation of relative risks and other epidemiologic measures in studies of common outcomes and in case-control studies","volume":"160","author":"Greenland S","year":"2004","unstructured":"Greenland S. Model-based estimation of relative risks and other epidemiologic measures in studies of common outcomes and in case-control studies. Am J Epidemiol. 2004;160(4):301\u2013305."},{"issue":"7","key":"b23","series-title":"Am J Epidemiol","first-page":"702","article-title":"A modified Poisson regression approach to prospective studies with binary data","volume":"159","author":"Zou G","year":"2004","unstructured":"Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702\u2013706."},{"issue":"2","key":"b24","series-title":"World Neurosurg","first-page":"329","article-title":"Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of craniopharyngiomas","volume":"77","author":"Komotar RJ","year":"2012","unstructured":"Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH. Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of craniopharyngiomas. World Neurosurg. 2012;77(2):329\u2013341."},{"issue":"8-9","key":"b25","series-title":"Childs Nerv Syst","first-page":"691","article-title":"Craniopharyngioma: the pendulum of surgical management","volume":"21","author":"Sainte-Rose C","year":"2005","unstructured":"Sainte-Rose C, Puget S, Wray A,  Craniopharyngioma: the pendulum of surgical management. Childs Nerv Syst. 2005;21(8-9):691\u2013695."},{"issue":"9-10","key":"b26","series-title":"Neuroendocrinology","first-page":"767","article-title":"Diagnosis, background, and treatment of hypothalamic damage in craniopharyngioma","volume":"110","author":"Erfurth EM","year":"2020","unstructured":"Erfurth EM. Diagnosis, background, and treatment of hypothalamic damage in craniopharyngioma. Neuroendocrinology. 2020;110(9-10):767\u2013779."},{"issue":"1","key":"b27","series-title":"Neurosurgery","first-page":"110","article-title":"Endoscopic, endonasal resection of craniopharyngiomas: analysis of outcome including extent of resection, cerebrospinal fluid leak, return to preoperative productivity, and body mass index","volume":"70","author":"Leng LZ","year":"2012","unstructured":"Leng LZ, Greenfield JP, Souweidane MM, Anand VK, Schwartz TH. Endoscopic, endonasal resection of craniopharyngiomas: analysis of outcome including extent of resection, cerebrospinal fluid leak, return to preoperative productivity, and body mass index. Neurosurgery. 2012;70(1):110\u2013124."},{"key":"b28","series-title":"Front Neurol","first-page":"737743","article-title":"Endocrine disorder in patients with craniopharyngioma","volume":"12","author":"Zhou Z","year":"2021","unstructured":"Zhou Z, Zhang S, Hu F. Endocrine disorder in patients with craniopharyngioma. 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