OR16-3 Posterior Hypothalamus-Sparing Surgery Improves Outcome after Childhood Craniopharyngioma: Results of the Prospective Multinational Trial Kraniopharyngeom 2007

Background: Quality of survival (QoS) is frequently impaired in childhood-onset craniopharyngioma (CP) patients by hypothalamic syndrome. The debate, whether pretreatment hypothalamic involvement (HI) has apriori prognostic impact or treatment-related hypothalamic lesions (HL) determine outcome, is controversial. Methods: In cross-sectional prospective study, survival and outcome of 109 CPs recruited 2007-2014 in KRANIOPHARYNGEOM 2007 with reference-confirmed presurgical, anterior and posterior HI were analyzed with regard to surgical HL (no, anterior or anterior and posterior HL). Body mass index (BMI), QoS assessed by PEDQOL, and functional capacity (FMH) were measured at diagnosis, during follow-up, and at last visit (median follow-up: 6 years). Results: Surgical HL were reference-confirmed in 86 of 109 (79%) CP (29 anterior, 57 anterior and posterior HL). PFS and BMI at diagnosis were similar in CP subgroups with different degree of HL. CP with anterior and posterior HL presented with higher BMI at one-year follow-up (median BMI: +5.21 SD) and at last visit (BMI: +5.74 SD), when compared to patients without HL (BMI, one year: +1.72 SD, p=0.001; last visit BMI: +2.27 SD, p<0.001) and when compared to patients with anterior HL (BMI, 1 year: +2.46 SD, p=0.002; last visit: +2.87 SD, p=0.001). QoS improved during follow-up in CP without HL for physical functionality (p=0.047), emotional stability (p=0.040), and social functionality (p=0.002) when compared to CP with anterior and posterior HL. Functional capacity was not associated with degree of HL. Conclusions: Based on appropriate preoperative staging, posterior hypothalamus-sparing surgical strategies do not increase risk for relapse/progression, improve QoS and ameliorate development of obesity in CP at risk for obesity due to presurgical anterior and posterior HI.