Long-term quality of life in adult craniopharyngioma patients: correlation with pituitary stalk section after endoscopic endonasal surgery

PURPOSE: Craniopharyngiomas are benign but locally aggressive tumors whose surgical treatment poses a challenge due to their proximity to critical structures. While gross total resection (GTR) may reduce recurrence risk, it often leads to significant long-term morbidity, especially when the pituitary stalk is sacrificed. This study aims to assess health-related quality of life (QoL) in adult patients undergoing endoscopic endonasal approach (EEA) for craniopharyngioma, with a focus on the impact of pituitary stalk section. METHODS: We retrospectively analyzed 35 adult patients who underwent EEA for histologically confirmed craniopharyngioma between April 2012 and September 2023. Inclusion criteria were age > 18 years and at least one year of follow-up. Patients completed a custom 8-item telephone questionnaire assessing the impact of hormone replacement therapy (HRT), visual changes, hypothalamic dysfunction (sleep, appetite, sexual and behavioral disturbances), and nasal or olfactory symptoms. Each item was rated on a 1-5 scale, and patients identified the most burdensome symptom. RESULTS: Older patients (> 55 years), those without preoperative panhypopituitarism, and those with postoperative hormonal decline reported higher impact. Visual deficits significantly affected QoL, particularly when vision worsened postoperatively. Obese patients (BMI > 30) reported greater impact from weight gain. Sleep disturbances were more prevalent in adamantinomatous craniopharyngiomas, while behavioral changes were more frequent in older patients. Smokers reported more nasal breathing issues. Sexual dysfunction was more frequently reported by males, older patients, and those who had stalk resection or new endocrine deficits. Stalk section was significantly associated with higher GTR rates but also with worsened endocrine function and higher cumulative QoL burden. CONCLUSIONS: Pituitary stalk resection increases GTR likelihood but at the cost of greater long-term endocrine morbidity. Patient age and baseline function significantly influence postoperative QoL, underscoring the importance of individualized surgical planning.