Complications of Surgery

The surgical resection of craniopharyngiomas is associated with significant risks to endocrine function and vision. The most common postoperative complication is diabetes insipidus, which occurs in 59% to 93% following surgery.17,27,28,58,62,68,76 All patients undergoing open resection should be warned of the very high likelihood of requiring lifelong therapy to treat partial or complete diabetes insipidus. Fahlbusch et al noted that normal preoperative anterior pituitary function was maintained in approximately 50% of patients after surgery, and the incidence of hypogonadism increased only from 77% to 80%.17 However, other series note that panhypopituitarism occurs in

75% to 100% of patients who undergo surgical resection.11,12,33 Visual deterioration occurred in 2% to 45% of patients who underwent surgical resection.17,53

Hypothalamic injury leads to debilitating consequences such as obesity, disorders of temperature regulation, somnolence, cardiorespiratory instability, and diabetes insipidus. Following surgery, up to 40% of patients experience debilitating weight gain of 12 to 20 kg/year, which persist without plateau. Suppression of insulin secretion has been shown to be effective in preventing or reversing this complication.42 Minor surgical trauma to the hypothalamus can also cause sleep disorders, memory problems, apathy, and appetite changes.7,61

Neuropsychologic and behavioral disturbances were found in 36% to 60% of children who underwent radical resec-tion.1,33,59,72 A decrease in school performance and learning disability occurs in up to a third of children.59,72,78 Merchant et al found a drop in IQ scores of 9.8 points in 15 pediatric patients.45 Whereas neuropsychologic outcome is most often studied in children, adults can have neuropsychologic sequelae as well. Donnet et al found in a study of 22 adults that 9% had severe memory and intellectual deficits and 14% had moderate learning deficits.13 Van Effenterre et al, in contrast, found in a study of 122 patients that the rate of normal neuropsychologic function was 91% as assessed by patients and their families.69

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