Novel predictive scoring system for morbid hypothalamic obesity in patients with pediatric craniopharyngioma
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ORIGINAL ARTICLE
Novel predictive scoring system for morbid hypothalamic obesity in patients with pediatric craniopharyngioma Mohammed A. Fouda 1,2 & David Zurakowski 3 & R. Michael Scott 1 & Karen J. Marcus 4,5 & Peter E. Manley 6 & Nicole J. Ullrich 5,7 & Laurie E. Cohen 6 & Liliana C. Goumnerova 8 Received: 9 August 2020 / Accepted: 31 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To identify the independent risk factors for developing morbid hypothalamic obesity, to propose a predictive scoring system for morbid hypothalamic obesity, and to propose an algorithm for management in order to minimize the risk of developing morbid hypothalamic obesity in patients with pediatric craniopharyngioma. Methods A retrospective analysis of all pediatric craniopharyngioma patients diagnosed and treated at Boston Children’s Hospital (BCH) between 1985 and 2017. Analysis of the data was conducted using IBM SPSS Statistics. Results We identified 105 patients, 90 (47 males and 43 females) fulfilled the inclusion criteria. The median age of patients at time of diagnosis was 8.4 years. The median follow-up was 10.6 years. Morbid hypothalamic obesity was evident in 28 (31.1%) patients at the last follow-up visit. Age of patients at time of diagnosis > 10 years (P = 0.023), preoperative body mass index (BMI) > 95th percentile (P = 0.006), and preoperative papilledema (P < 0.001) were the independent risk factors for developing morbid hypothalamic obesity. Conclusion We developed a unique predictive scoring system in order to differentiate between patients with and without high risk for developing morbid hypothalamic obesity. Keywords Pediatric . Craniopharyngioma . Hypothalamic . Obesity . Scoring - algorithm
Introduction
* Mohammed A. Fouda [email protected] 1
Department of Neurosurgery, Boston Children’s Hospital, Boston, MA, USA
2
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
3
Division of Biostatistics, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
4
Division of Radiation Oncology, Boston Children’s Hospital, Boston, MA, USA
5
Dana Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA, USA
6
Division of Endocrinology, Boston Children’s Hospital, Boston, MA, USA
7
Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
8
TromboProtea Inc, Boston, MA, USA
Craniopharyngioma is a rare epithelial brain tumor that develops from embryological remnants of Rathke’s pouch—a remnant of the primitive pharynx [2, 6, 7, 9, 11, 12]. Craniopharyngioma accounts for 1 to 3% of the pediatric intracranial tumors [4, 6, 11, 12]. It is typically located in the sellar and suprasellar regions [2, 6, 11, 12]. Pediatric craniopharyngioma commonly causes obstruction of the cerebral spinal fluid (CSF) outflows manifesting as hydrocephalus (HCP) and elevated intracranial pressure (ICP) [11, 18, 38]. It is reported in the literature that 40 to 87% of patients ha
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