Endocrine Abstracts (2017) 49 GP182 | DOI: 10.1530/endoabs.49.GP182

Brain white matter damage and volumes of hippocampus and hypothalamus correlates to cognitive function in craniopharyngioma

Sigridur Fjalldal1, Daniel Svärd2, Cecilia Follin1, Danielle Van Westen2, Sanaz Gabery3, Æsa Petersén3, Magdalena Jansson4, Pia Maly Sundgren2,5, Isabella Björkman-Burtscher2,5, Jimmy Lätt5, Peter Mannfolk5, Carl-Henrik Nordström7, Lars Rylander8, Bertil Ekman9, Aki Johansson4 & Eva-Marie Erfurth1


1Department of Endocrinology, Skåne University Hospital, Lund, Sweden; 2Department of Diagnostic Radiology, Clinical Sciences, Lund University, Lund, Sweden; 3Translational Neuroendocrine Research Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden; 4Department of Psychology and Psychiatry, Skåne University Hospital, Lund, Sweden; 5Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden; 6Lund University BioImaging Center, Lund University, Lund, Sweden; 7Department of Neurosurgery, Skåne University Hospital, Sweden, Lund, Sweden; 8Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; 9Department of Endocrinology and Medical and Health Sciences, Linköping University, Linköping, Sweden.


Introduction: Adult patients with craniopharyngioma (CP) and hypothalamic (HT) damage have impaired cognitive function. The white matter (WM) changes behind these findings remain to be elucidated. Diffusion tensor imaging (DTI) is a MRI technique that quantifies microstructural damage in the WM. This is the first study of DTI, hippocampal (HC) and HT volume in relation to cognition in CP patients.

Methods: A cross-sectional study of childhood onset CP was performed at median 22 years after first operation. After exclusions, 36 patients and 31 controls remained in the MRI study. Main outcome measures were comparison of cognitive tests, volume measurements of HC and HT and the DTI parameters median diffusivity (MD) and fractional anisotropy (FA) between patients and controls.

Results: CP patients have WM damage in the left dorsal cingulum and right uncinate fasciculus. No significant difference was found on DTI measurements of the HC. Correlations were found between DTI results from the right uncinated fasciculus (MD, P=0.035 and FA, P=0.005) and the left HC (MD, P=0.035 and FA, P=0.001) with long term memory reflecting general knowledge. DTI in the cingulum correlated with visual memory (MD, P≤0.04 and FA, P≤0.04) and short term memory (MD, P=0.004). DTI in the HC correlated with long term memory (MD, P=0.03 and FA, P≤0.046) and short term memory (FA, P=0.02). HT volume correlated negatively with MD of right uncinate fasciculus (P=0.015). The CP patients had a smaller HC volume which correlated with long term memory (P=0.016).

Conclusions: A structure to function relationship is established between cognition and WM damage detected with DTI in CP. CP patients have a smaller HC compared to controls. Whether the cognitive deficits are a direct consequence of HT damage or an indirect effect on frontotemporal network remains to be elucidated.