Endocrine Evaluation Following Aggressive Surgical Resection of Craniopharyngiomas in Children（Report of 782 cases)

Objective: A retrospective study assessed the endocrinological outcomes of aggressive surgical tumor resection in pediatric patients, focusing on the treatment's efficacy and safety. Patients and methods: 782 craniopharyngioma pediatric patients were treated surgically from January 2004 to May 2023. There were 62.9% boys and 37.1% girls, with mean ages of 8.09±3.67 years ranging from 8 months to 15 years old. The tumor size in pediatric patients ranged from 1.1cm to 16cm in maximal diameter, with an average diameter of 3.84±1.47 cm. 82.1% of the tumors had calcified tumors with 6.3% huge calcified masses of 1.5 cm diameter. Results : Total removal of tumors were achieved in 90.2%. The pituitary stalk was intentionally preserved in 87.1% cases despite partial injury or remains intact with peeling off the residual tumor. Within the perioperative period, there were 2.7% deaths. Of the remaining patients, 77.6% were followed up for an average of 3.9 years. Out of 607 patients, 92.3% had total tumor removal and other had a subtotal or partial resection. At a 1.5-year follow-up after surgery, hormone levels showed no improvement compared to the deficits observed during the perioperative period. A total of 71.3% patients with an endocrine disturbance required postoperative substitution of the deficient hormone. 11.6% of the patients with total tumor removal experienced recurrence in an average of 3.3 years, while 91.5 % of patients with subtotal or partial resection had tumor progression within an average of 0.5 years. Conclusion: Transcranial surgery allows for gross total removal of the tumor to achieve free survival in most pediatric patients, which enables precise targeting of the tumor while minimizing interference from its specific characteristics.The morbidity of hormone deficits and hypothalamic obesity presents a challenge to the surgical aggressive resection of the tumor.