ESPE Abstracts

Background: Childhood craniopharyngioma (cCP) poses significant risks of hypothalamic damage, leading to severe obesity in up to 75% of survivors. Despite hypothalamus-sparing surgical techniques, hypothalamic obesity remains a prevalent issue. We aim ed to fill a critical gap by exploring the presence of hypothalamic inflammation and gliosis following cCP surgery on MRI. In the future we will correlate our findings to subsequent hypothalamic dysfunction and obesity.

Methods: We conducted a retrospective analysis of two childhood craniopharyngioma cohorts; the Dutch cohort (diagnosed between 2018-2023, n = 40), and the German cohort (diagnosed 2019-2023, n = 72). For our study, we assessed MRI scans preoperatively, immediately postoperatively, and at 3, 6,12 months follow-up intervals, focusing on increased T2-weighted and FLAIR signal changes indicative of hypothalamic inflammation and gliosis. For this aim, we measured the average signal intensity ratios of the hypothalamus to other grey matter zones at each time point (the left and right medial basal hypothalamus (MBH) /amygdala ratio and the left and right MBH/putamen ratio).

Results: Preliminary results indicate that the MBH/amygdala and the MBH/putamen ratios on T2 and FLAIR both increase post-surgery in cCP patients, which may be indicative of inflammation and gliosis.

Discussion: We hypothesize that hypothalamic inflammation will correlate with significant BMI increases in the first year post-surgery. Furthermore, we expect that the extent of postoperative inflammation will predict the severity of hypothalamic dysfunction, including hyperphagia, behavioral problems, and sleep disorders. The anticipated findings will explain the pathomechanisms linking post-operative hypothalamic obesity to hypothalamic inflammation and gliosis, providing insights for potential preventive and therapeutic strategies. Body Mass Index (BMI) and other clinical information were collected at these intervals to correlate inflammation with obesity outcomes. We are currently working on the analyses and expect to conclude the results by autumn 2024 at ESPE 2024.