ESPE Abstracts

Background: Cerebral infarction (CI) is a known vascular complication following treatment of suprasellar tumors. The purpose of our study was to determine the incidence of cerebral infarction (CI) in a cohort of 244 German childhood-onset craniopharyngioma (CP) patients recruited between 2007 and 2019 with a high degree of completeness in the prospective, randomized trial KRANIOPHARYNGEOM 2007 (Clinical Trial No. NCT01272622). Up to now, risk factors for CI, incidence rate, and long-term prognosis are unknown for patients with childhood-onset CP.

Methods: The MRI of 244 CP patients, recruited between 2007 and 2019 in KRANIOPHARYNGEOM 2007, were reviewed for CI by neuroradiologists blinded for clinical information. Risk factors for CI and outcome after CI were analyzed. The Pediatric Quality of Life (PEDQOL) and the German daily life ability scale Fertigkeitenskala Münster-Heidelberg (FMH) questionnaires were used to assess health-related QOL and functional capacity, respectively.

Results: Twenty-eight of 244 patients (11%) presented with CI based on reference assessment of MRI. One CI occurred before initial surgery and one case of CI occurred after release of intracystic pressure by a cyst catheter. 26 of 28 CI were detected after surgical tumor resection at a median postoperative interval of one day (range: 0.5-53 days). Vascular lesions during surgical procedures were documented in 7 cases with CI. No relevant differences with regard to surgical approaches were found. In all 12 irradiated patients, CI occurred before irradiation. Multivariable analyses showed that hydrocephalus and gross-total resection at the time of primary diagnosis/surgery both were risk factors for CI. After CI, quality of life (PEDQOL) and functional capacity (FMH) were impaired.

Conclusions: CI occurs in 11% of surgically-treated CP cases. Degree of resection and increased intracranial pressure are risk factors, which should be considered in the planning of surgical procedures for prevention of CI. We conclude that especially initial hydrocephalus and radical surgical procedures such as gross-total resection leading to complete resection in complicated tumor locations such as hypothalamic involvement and adhesion of vessels, increase the risk of CI. CI leads to severe impairment of QOL and functional capacity during long-term follow-up after childhood-onset CP.