Hypothalamic Invasion Score:Prediction For Postoperative Outcomes Of Patients With Craniopharyngioma

Object: The perioperative mortality in patients with craniopharyngioma(CP)is high.Their quality of life after surgery is often lower than that before surgery and everyone is different.In this study,we proposed a hypothalamic invasion scoring system(HTIS)based on preoperative MRI in patients with CP to predict postoperative prognosis and to provide a theoretical basis for the planning treatment.Methods: This was a retrospective analysis of 70 patients with CP who had undergone endoscopic transnasal surgery treatments by the same surgeon.We gathered imaging data,symptoms and signs,laboratory examinations,surgical videos,total resection rates and mortality rates from all patients.Every patient was followed up for a long period.The HTIS was established using preoperative nuclear magnetic resonance imaging(MRI)and we determined association with postoperative complications and quality of life.Results: Patients with high HTIS more frequently developed lethargy,hydrocephalus,memory loss,unconsciousness and walking unsteadily prior to surgery(P=0.008,P=0.007,P=0.007,P=0.049),as well as neuropsychological dysfunction and disturbances of consciousness after operation(P=0.023,P=0.009),suggesting they are often to have more severe complications with high HTIS.There were significant differences in postoperative Karnofsky performance scale(KPS)among different HTIS groups(X2=31.250,df=3,P<0.001),implying that various HTIS correlated with varying long-term quality of life.There was a negative correlation between HTIS and KPS(correlation coefficient-0.648,P<0.001),implying that patients with the higher preoperative HTIS score have worse postoperative long-term quality of life.The total resection rate was 96.83%,the perioperative mortality was 7.14% and the tumor recurrence rate was 9.52%.Conclusion: The extent of invasion of the hypothalamus can be calculated using the preoperative MRI in patients with CP.The perioperative outcomes and long-term quality of life of patients with CP can be predicted using our novel scoring system.