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Neurosurg Focus. 2016 Dec;41(6):E12.

Postoperative outcome of body core temperature rhythm and sleep-wake cycle in third ventricle craniopharyngiomas.

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Center of Surgery for Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche.
Department of Biomedical and Neuromotor Sciences, University of Bologna.
IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital.
Anatomic Pathology, Bellaria Hospital, University of Bologna.
Department of Pharmacology and Biotechnology, University of Bologna.
Department of Medicine, Anatomic Pathology-Molecular Diagnostic Unit, Azienda Sanitaria Locale of Bologna, University of Bologna School of Medicine; and.
Ear, Nose and Throat Department, Bellaria Hospital, Bologna, Italy.


OBJECTIVE One of the more serious risks in the treatment of third ventricle craniopharyngiomas is represented by hypothalamic damage. Recently, many papers have reported the expansion of the indications for the endoscopic endonasal approach (EEA) to be used for these tumors as well. The aim of this study was to assess the outcome of sleep-wake cycle and body core temperature (BCT), both depending on hypothalamic control, in patients affected by craniopharyngiomas involving the third ventricle that were surgically treated via an EEA. METHODS All consecutive adult patients with craniopharyngiomas that were treated at one center via an EEA between 2014 and 2016 were prospectively included. Each patient underwent neuroradiological, endocrinological, and ophthalmological evaluation; 24-hour monitoring of the BCT rhythm; and the sleep-wake cycle before surgery and at follow-up of at least 6 months. RESULTS Ten patients were included in the study (male/female ratio 4:6, mean age 48.6 years, SD 15.9 years). Gross-total resection was achieved in 8 cases. Preoperative BCT rhythm was pathological in 6 patients. After surgery, these disturbances resolved in 2 cases, improved in another 3, and remained the same in 1 patient; also, 1 case of de novo onset was observed. Before surgery the sleep-wake cycle was pathological in 8 cases, and it was restored in 4 patients at follow-up. After surgery the number of patients reporting diurnal naps increased from 7 to 9. CONCLUSIONS The outcome of the sleep-wake cycle and BCT analyzed after EEA in this study is promising. Despite the short duration of the authors' experience, they consider these results encouraging; additional series are needed to confirm the preliminary findings.


BCT = body core temperature; BMI = body mass index; DI = diabetes insipidus; EEA = endoscopic endonasal approach; GTR = gross-total resection; MESOR = Midline Estimating Statistic of Rhythm; PTR = partial tumor resection; body core temperature rhythm; body mass index; craniopharyngioma; endoscopic endonasal approach; hypothalamus; sleep-wake cycle

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