333 The Degree of Hypothalamic Involvement and Its Effects on BMI in Pediatric Craniopharyngioma

INTRODUCTION: Craniopharyngioma (CP) is a benign tumor, yet it drastically affects patients' quality of life. Childhood obesity linked to increased risk of type 2 diabetes, liver and cardiovascular disease. METHODS: A retrospective analysis reviewed clinical variables, preoperative magnetic resonance imaging (MRI) scans to determine Puget grades: Grade 0, Grade 1, and Grade 2 on post-operative obesity (BMI > 95%) among craniopharyngioma patients. RESULTS: Fifty-five patients (27 female/28 male) participated. Pre-operative Puget Grades were: Grade 0 (2 subjects), Grade 1 (14 subjects), and Grade 2 (39 subjects). Ten had transsphenoidal and 45 open craniotomy procedures (interhemispheric, orbitalffrontal, vs pterional). Sixteen had GTR, 11 had STR, and 29 had STR with radiation (STR+). Pre-operative obesity was significantly higher in adolescents than younger patients (p<0.05). At one month post-op, BMI percentile increase was significant in open craniotomy versus transsphenoidal (p=0.002). Hypothalamic obesity was the only significant difference between obese and non-obese groups at one month (p=0.01). Six months post-op, BMI percentile differed significantly between GTR and STR (p=0.009), but not for STR patients who had radiation (p=0.268). Open craniotomy patients showed a notable BMI increase (p=0.002). Obese groups had higher rates of endocrinopathies and metabolic diseases: diabetes insipidus (p=0.03), central hypothyroidism (p=0.04), secondary adrenal insufficiency (p=0.03), and hypothalamic obesity (p=0.01). Puget grade was not significant at 1- and 6-months (p=0.16, p=0.11, respectively). A multivariate cox-regression evaluated Puget grade, hypothalamic obesity, EOR, and operative approach on obesity which demonstrated that only hypothalamic obesity was a significant factor on patients’ outcomes (p<0.001). CONCLUSIONS: Patient outcomes are only available post-op 6 months. Since BMI doesn't significantly differ between GTR and STR, achieving transsphenoidal resection with GTR is crucial for improving patient quality of life and reducing recurrence rates.