| Background: Craniopharyngioma is a rare congenital intracranial tumor.At present,most scholars agree that craniopharyngioma originates from the squamous cell remnants of Lacke’s bursa in embryo.Its histopathology is benign tumor,but due to its special growth site and the characteristics of easy recurrence,the treatment of this disease is still a controversial topic in the academic circle.The previous treatment of this disease focused on whether the tumor was completely resected and the survival rate of patients.With the rapid development of technology over the past decades,the mortality rate of patients has been significantly reduced,and the focus of treatment has tended to improve the quality of life of patients after surgery.Now it has been recognized that the postoperative complications of craniopharyngioma patients are closely related to the injury of the hypothalamus.It is of great significance to avoid the injury of the hypothalamus as much as possible in the treatment process to improve the prognosis of patients and reduce the related complications.Hypothalamic obesity is a thorny problem in a series of postoperative complications related to craniopharyngioma.The disease has a serious impact on patients from the perspective of social psychology and physiology,and is not sensitive to treatment.Drug treatment is often difficult to achieve a good effect,and usually requires surgical intervention.Therefore,it is particularly important to prevent the occurrence of this disease.Our study analyzed the related risk factors affecting the occurrence of hypothalamic obesity.Previous studies on the prognostic factors of craniopharyngioma patients were mostly analyzed from the perspectives of tumor size,texture,calcification,etc.,and this study aimed to find a way to evaluate the prognosis of patients with craniopharyngioma through imaging data.PUGET classification for hypothalamic injury was first proposed in 2007,which was mainly used by foreign scholars to evaluate the relative positional relationship between craniopharyngioma and hypothalamus,so as to formulate reasonable surgical strategies.We are the first to analyze the association between PUGET rating and postoperative complications in patients with craniopharyngioma,and for the first time to explore the value of this rating in predicting postoperative complications in patients with craniopharyngioma.Objective: 1.Evaluate the degree of postoperative hypothalamic involvement in patients with craniopharyngioma according to the PUGET rating of hypothalamic injury,analyze its correlation with prognosis and complications,and discuss the prognostic value of PUGET rating of hypothalamic injury in patients with craniopharyngioma;2.To investigate the risk factors of hypothalamic obesity in patients with craniopharyngioma after surgery.Methods: Data of 89 craniopharyngioma patients in the Neurosurgery Department of the Affiliated Hospital of Qingdao University from May 2013 to October 2018 were collected(including height,weight,age at onset,preoperative craniocerebral MRI,and postoperative tumor pathological types).Long-term follow-up was conducted to understand the patients’ height and weight changes,recent changes in urine volume,postoperative reexamination of brain MRI data,endocrine,visual and visual fields,the need for oral hormone replacement therapy,work and learning ability,life and social interaction,etc.,and to evaluate the overall prognosis of the patients.1.Puget classification was used to evaluate the degree of postoperative hypothalamic injury in 89 patients,and statistical methods were used to analyze the relationship between postoperative hypothalamic injury and complications in craniopharyngioma patients.2.A binary logistic regression model was established to analyze the correlation between craniopharyngioma patients’ gender,onset age,tumor size,tumor pathological type,preoperative BMI and degree of tumor resection and postoperative hypothalamic obesity.Results: Of the 89 patients who received surgical treatment,14 cases of hypothalamic injury grade 0,41 cases of grade 1,34 cases of grade 2,12 cases of PUGET grade 0patients had good prognosis,and 2 cases had poor prognosis.Thirty-one patients with grade 1 hypothalamic injury had good prognosis and 10 had poor prognosis.7 patients with craniopharyngioma with injury level 2 had good prognosis,while 27 patients had poor prognosis.Five patients died due to severe postoperative complications,and the degree of hypothalamic injury in all the dead patients was grade 2.These five patients were not included in the correlation analysis of hypothalamic obesity and persistent diabetes insipidus.Of the 14 patients with hypothalamic injury with PUGET grade 0,none developed persistent diabetes insipidus at follow-up,and 2 patients(14.3%)developed hypothalamic obesity.Among the 41 PUGET grade 1 patients,5 patients(12.2%)developed persistent diabetes insipidus,and 9 patients(21.95%)developed hypothalamic obesity.At follow-up,12(41.4%)of 29 patients with grade 2 hypothalamic injury developed persistent diabetes insipidus,and 13(44.8%)developed hypothalamic obesity.PUGET grade had a good correlation with the prognosis of patients with hypothalamic injury and the prevalence of persistent diabetes insipidus after surgery(P <0.05).Further pairwise comparison showed that PUGET grade 2 patients had a worse prognosis compared with grade 0 and grade 1 patients,and the prevalence of persistent diabetes insipidus after surgery was higher(P < 0.001).However,there was no significant difference in prognosis and prevalence of persistent diabetes insipidus between PUGET grade 0 and grade 1 patients(P > 0.05).There was no significant correlation between PUGET grade and the incidence of postoperative hypothalamic obesity(P > 0.05).There were no significant differences in the prevalence of postoperative hypothalamic obesity among gender,onset age,tumor volume and tumor pathological type(P > 0.05).Preoperative BMI and degree of surgical resection in craniopharyngoma patients were risk factors for postoperative hypothalamic obesity.The risk of postoperative hypothalamic obesity increased by 95.5% for every 1 unit increase in BMI value(OR=1.955,95%CI: 1.418-2.694).The risk of hypothalamic obesity after total tumor resection was approximately 12 times that of partial tumor resection(OR=12.09,95% CI:1.41-103.80).Conclusion: 1.According this study,we found that PUGET classification for hypothalamic injury was of certain clinical guiding significance in evaluating the prognosis of patients with craniopharyngioma.PUGET grade 2 patients had a poorer prognosis compared with grade 0 and grade 1 patients,and had a higher incidence of persistent diabetes insipidus after surgery.2.Preoperative BMI value of craniopharyngioma patients is a predictor of hypothalamic obesity.The higher the BMI value of patients at the time of treatment,the greater the risk of postoperative hypothalamic obesity.3.Intraoperative enhancement of hypothalamus protection in patients with craniopharyngioma is helpful to improve the prognosis of patients.For tumors closely associated with the hypothalamus,radical resection is not conducive to improving the postoperative quality of life of patients,and will increase the risk of hypothalamic obesity. |
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