Panhypopituitarism and Craniopharyngioma Removal Surgery: is conservative resection better?

Abstract

Purpose: This study aims to predict if a craniopharyngioma (CF) removal surgery that spares brain structure, has a lower incidence of panhypopituitarism (PH), considering patients pituitary deficits prior surgery. Methods: A retrospective cohort study of patients who underwent CP removal surgery over a period of 17,5 years at Centro Hospitalar Universitário de São João, considering pituitary deficits prior surgery, was performed. The type of removal surgery the patients underwent, was classified as total, subtotal or partial, according to medical reports. The occurrence of PH was assessed based on medical reports as well. Results: A total of 43 patients were identified and then divided in a non-pituitary deficits prior surgery group, 23 cases, and in a pituitary deficits prior surgery group, 20 cases. In the first group, PH occurred in 4 cases (17,4%) of total removals, 5 cases (21,7%) of subtotal removals and in 3 cases (13,0%) of partial removals. However, the type of removal surgery performed did not demonstrate to be associated to the fresh occurrence of PH (5%, p=0.742). Furthermore, regarding other subgroups analyses performed, postoperative complications were associated with the occurrence of PH after CP removal surgery. Conclusions: Regarding the fact this study was not able to demonstrate that the type of CP removal surgery performed is related to PH, nowadays, there is the evidence that pituitary conservative surgeries, followed by radiotherapy, may also treat CP, with less morbidity and higher quality of life (QoL). Furthermore, we were able to observe that postoperative complications are associated with PH.