Comparative Hypothalamic and Endocrinological Outcomes of Craniopharyngiomas Based on Infundibulum Sacrifice vs. Preservation: A Retrospective, Multi-center Rapid Consortium Study

Background and Objectives: Craniopharyngioma surgery is a balance between gross total resection and neurovascular complication avoidance, including hypothalamic dysfunction. One surgical nuance is the preservation or sacrifice of the pituitary infundibulum to aid in tumor resection. In this multicenter, retrospective study, we evaluate preservation of the infundibulum during endoscopic endonasal surgery and its effects on postoperative hypothalamic-pituitary function and craniopharyngioma tumor recurrence. Methods: Retrospective analysis of patients enrolled in a multicenter consortium (Registry of Adenomas of the Pituitary and Related Disorders, RAPID) who underwent surgical treatment for craniopharyngioma was performed. Patient demographics and tumor characteristics were obtained including pathology and imaging features (tumor morphology, and proximity to the chiasm and infundibulum). Patients were grouped based on infundibulum preservation versus resection during surgery. Primary outcomes included hypothalamic dysfunction (temperature regulation, weight gain, circadian rhythm), endocrine deficiencies (arginine vasopressin deficiency, adrenal insufficiency, hypothyroidism, growth hormone deficiency), pre-operative and postoperative body mass index (BMI), length of stay (LOS) and tumor recurrence. Chi-square analysis was used to evaluate differences between categorical variables. Nonparametric tests were used to evaluate differences between continuous variables. Results: 576 patients were enrolled in the database, but 200 were excluded from analysis due to lack of infundibulum preservation data. Median follow-up was 12 months (3s-60 months). Of the 376 patients evaluated, 271 (72.1%) patients had adamantinomatous craniopharyngioma while 87 (23.1%) had papillary craniopharyngioma. The infundibulum was preserved in 237 (63%) patients. Post-operative radiation was performed in 26.6% patients. Gross total resection was lower in the infundibulum preservation group (65.5% v 47.6%; p < 0.001) Tumor recurrence was higher in the infundibulum preservation group (24.3% v 14.5%; p = 0.05) and infundibulum resection led to lower rates of post-operative radiation (15.8%, n = 22) compared with stalk-preservation (32.9%, n = 78) (p=