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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2012 August;25(4):301-10
Postsurgical obesity in 3rd ventricular tumours: new pathophysiological perspectives
Hildebrandt G. 1, Brändle M. 2, Stienen M. N. 1, Gautschi O. P. 1, Van Leyen K. 1
1 Department of Neurosurgery, State Hospital St.Gallen, St.Gallen, Switzerland;
2 Department of Endocrinology, State Hospital St.Gallen, St.Gallen, Switzerland
Surgery of tumours in the region of the 3rd ventricle belongs to the most challenging tasks of the neurosurgeon. Postoperative endocrine disorders account for severe morbidity with heavy impact on the patient’s life. It was our intention to focus on endocrinologic issues associated with surgery of 3rd ventricle tumours and the vicinity of the hypothalamus. All cases of tumour resection of the 3rd ventricle via the translaminar approach between 01/2007 and 01/2010 were considered. Neurologic, neuroradiologic, endocrinologic and ophthalmologic parameters were analyzed in order to find parameters being positively or negatively associated with diabetes insipidus and postoperative obesity. Furthermore, a review of the current knowledge on hypothalamic control of food-intake and energy metabolism is provided. Three cases with a mean age of 24.0 years and mean preoperative body mass index (BMI) of 23.3kg/m2 were identified. Histopathological diagnoses were craniopharyngeoma, pilocytic astrocytoma and germinoma. A mean follow-up of 27.06 months was conducted. Postoperative severe obesity occurred in all three patients with a mean BMI of 33.2kg/m2 after six months. Mean serum prolactin levels were 30.3µg/l pre- and 60.6µg/l three months postoperatively. Obesity correlated with hypothalamic damage in the postoperative MRI and high serum prolactin levels.
Conclusion. Obesity and diabetes insipidus centralis as consequences of surgery occurred in all patients operated via the translaminar route. A massive increase in body weight was observed, which proved hard to be influenced through dietary means alone. Further research is needed to ameliorate quality of life in those patients with good prognosis.