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Purpose <p>Postoperative weight gain following endoscopic endonasal surgery (EES) for craniopharyngiomas remains a challenging complication. Thus, in this study, we aimed to identify risk factors for new or worsened obesity following EES and to explore age-related patterns of postoperative weight change.</p> Methods <p>We conducted a retrospective cohort study of 72 patients (26 pediatric and 46 adult) who underwent initial EES for craniopharyngioma at two academic centers. We defined obesity based on body mass index (BMI) in adults and the BMI standard deviation score in pediatric patients. The primary outcome was new or worsened obesity at follow-up. Tumor extension and hypothalamic involvement/damage were assessed using standardized classification systems. Multivariate logistic regression was used to identify independent predictors.</p> Results <p>New or worsened obesity was observed in 17 patients (23.6%). Retroinfundibular tumor extension (odds ratio [OR]: 9.81; <i>p</i> = 0.002) and postoperative hypothalamic damage (OR: 7.72; <i>p</i> = 0.016) were independently associated with new or worsened obesity. However, surgical factors, including resection and operative complexity, were not significant predictors. Subgroup analyses revealed that a subset of pediatric patients developed early-onset and persistent obesity, whereas adults (particularly young adults) experienced gradual weight gain.</p> Conclusion <p>Retroinfundibular tumor extension and hypothalamic damage are key risk factors for postoperative obesity following EES, whereas aggressive resection itself does not increase the risk. Pediatric patients may develop obesity early and persistently, whereas adults, particularly young adults, are prone to gradual weight gain. Early diagnosis and strategic treatment for high-risk individuals may improve the prognosis for patients with hypothalamic obesity.</p>

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Postoperative weight gain following endoscopic endonasal surgery for craniopharyngiomas in children and adults: A retrospective cohort study

  • 期刊论文

  • 发表日期：

    2025年10月10日

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  • Takeshi Hongo,
  • Hiroyoshi Akutsu,
  • Yusuke Morinaga,
  • Shunsuke Shibao,
  • Sotaro Oshida,
  • Yasuhiro Tsunemi,
  • Takashi Kashiwagi,
  • Tsuguhisa Nakayama,
  • Takuya Tomaru,
  • Tomohiro Otaka,
  • Hiroyoshi Kino,
  • Takuma Hara,
  • Shuho Tanaka,
  • Tetsuya Yamamoto

摘要

Purpose

Postoperative weight gain following endoscopic endonasal surgery (EES) for craniopharyngiomas remains a challenging complication. Thus, in this study, we aimed to identify risk factors for new or worsened obesity following EES and to explore age-related patterns of postoperative weight change.

Methods

We conducted a retrospective cohort study of 72 patients (26 pediatric and 46 adult) who underwent initial EES for craniopharyngioma at two academic centers. We defined obesity based on body mass index (BMI) in adults and the BMI standard deviation score in pediatric patients. The primary outcome was new or worsened obesity at follow-up. Tumor extension and hypothalamic involvement/damage were assessed using standardized classification systems. Multivariate logistic regression was used to identify independent predictors.

Results

New or worsened obesity was observed in 17 patients (23.6%). Retroinfundibular tumor extension (odds ratio [OR]: 9.81; p = 0.002) and postoperative hypothalamic damage (OR: 7.72; p = 0.016) were independently associated with new or worsened obesity. However, surgical factors, including resection and operative complexity, were not significant predictors. Subgroup analyses revealed that a subset of pediatric patients developed early-onset and persistent obesity, whereas adults (particularly young adults) experienced gradual weight gain.

Conclusion

Retroinfundibular tumor extension and hypothalamic damage are key risk factors for postoperative obesity following EES, whereas aggressive resection itself does not increase the risk. Pediatric patients may develop obesity early and persistently, whereas adults, particularly young adults, are prone to gradual weight gain. Early diagnosis and strategic treatment for high-risk individuals may improve the prognosis for patients with hypothalamic obesity.