2026 Poster Presentations
P292: EXTENT OF RESECTION AND BMI CHANGE AFTER ENDOSCOPIC CRANIOPHARYNGIOMA SURGERY: A COMBINED ADULT-PEDIATRIC COHORT
Jared Chung, BS1; Georgios Maragkos, MD2; Madhusmita Misra, MD3; Gregory Hong, MD4; Michael Catalino, MD2; John Jane Jr, MD5; 1University of Virginia School of Medicine; 2University of Virginia Department of Neurosurgery; 3University of Virginia Department of Pediatric Endocrinology; 4University of Virginia Department of Endocrinology; 5Carilion Clinic Department of Neurosurgery
Introduction: The impact of surgical extent on tumor control and postoperative body mass index (BMI) change in patients with craniopharyngioma is unclear across ages. Prior studies suggest that greater surgical extent can result in greater postoperative weight gain in such patients, and that approaches designed to spare the hypothalamus reduce this risk without clearly compromising tumor control. We combined adult and pediatric endoscopic cases to evaluate oncologic and vision outcomes and BMI change using multiple complementary metrics.
Objective: To compare tumor control and BMI change across management strategies in adult and pediatric patients with craniopharyngioma.
Methods: This was a single-institution retrospective cohort of 49 purely endoscopic cases treated from 2007 to 2024 (33 adults and 16 children). Gross total resection (GTR) was defined as 100% radiographic resection. Incomplete resections combined near-total (>95%), subtotal (90–95%), partial (<90%), and fenestration resections. Patients were categorized into three management groups: GTR, incomplete resection with adjuvant radiation, and incomplete resection without radiation. Outcomes included progression/recurrence, adjuvant radiation, repeat surgery, endocrine status, postoperative visual status, and BMI change. BMI change was assessed from the preoperative visit to 12–24 months post-surgery, and to most-recent follow-up using four complementary strategies: (1) continuous ΔBMI (kg/m²) and percent ΔBMI, (2) categorical percent-change bins (≥10% gain, 5 to <10% gain, stable −5% to <+5%, ≥5% loss), (3) binary >5% gain vs other, and (4) CDC BMI category transitions.
Results: Post-surgery, BMI increased more in children than in adults at both timepoints. After 12-24 months, median percent ΔBMI was 14% in children (p=0.02) and 6% in adults (p=0.003). At most recent follow-up, children increased their BMI by about 36.2% (p=0.0007) and adults by about 8.6% (p=0.01).
In adults, GTR was most favorable for tumor control. Progression/recurrence occurred in 0/22 after GTR, 1/7 (14%) after incomplete resection with radiation, and 3/4 (75%) after incomplete resection without radiation (p<0.001). Reoperation was less frequent after GTR (0 of 22) than after incomplete resection with radiation (1/7, 14%) or without radiation (2/4, 50%; p=0.015). Postoperative visual outcomes did not differ significantly across management strategies. The same was reported across BMI analyses at both timepoints, where there were no between-group differences for continuous ΔBMI or %ΔBMI, categorical percent-change bins, binary >5% gain, or CDC BMI category transitions.
In the pediatric cohort, progression/recurrence, reoperation, and visual outcomes were similar across groups. BMI did not differ between groups at either timepoint across all prespecified analytic strategies, including continuous and categorical measures, binary >5% gain, and pediatric percentile-class transitions with increase-only jump magnitudes.
Conclusions: Across the combined cohort, children experienced larger BMI increases over time than adults, irrespective of treatment grouping. In adults, GTR improved oncologic control without detectable differences in BMI change across management groups. In children, oncologic and visual outcomes were similar across strategies, and BMI change did not differ by management category. These results support pursuing GTR in adults when safely feasible and highlight the need for proactive counseling and longitudinal follow-up for BMI trajectories in pediatric patients.