Abstract
PurposeSevere fluctuations in plasma sodium concentration and plasma osmolarity, including central diabetes insipidus (CDI), may have significant influence on postoperative morbidity and mortality after pediatric brain tumor surgery.The aim of this study was to describe the frequency, severity and neurological consequences of these fluctuations in pediatric brain tumor survivors.MethodsA retrospective, multi-institutional chart review was conducted among all children who underwent brain tumor surgery in the sellar or suprasellar region in seven university hospitals in the Netherlands between January 2004 and December 2013.ResultsPostoperative CDI was observed in 67.5% of 120 included children. Fluctuations of plasma sodium concentration ≥ 10 mmol/L/24 h during the first ten postoperative days were seen in 75.3% of patients with CDI, with a maximum delta of 46 mmol/L/24 h. When compared to patients without CDI, altered mental status occurred more frequently in patients with postoperative CDI (5.1 vs. 23.5% respectively, p = 0.009). Low plasma sodium concentration was related to altered mental status and the occurrence of seizures. Frequency and severity of fluctuations in plasma sodium concentration during the first ten postoperative days were significantly higher in patients with permanent CDI at last follow-up than in patients with transient CDI or without CDI (p = 0.007).ConclusionPostoperative CDI is a common complication after pediatric brain tumor surgery in the sellar or suprasellar region. Extreme plasma sodium concentrations and large intra-day fluctuations still occur and seem to influence the postoperative neurological course. These results illustrate the need for intensive monitoring in a highly experienced center.
Highlights
Tumors in the sellar or suprasellar region account for approximately 10% of all pediatric brain tumors [1]
Relevant postoperative complications probably occurring independent of fluctuations in plasma sodium concentration were defined as the presence of infections, anemia requiring blood transfusions or hyperglycaemia requiring insulin therapy
Important postoperative complications probably occurring independent of fluctuations in plasma sodium concentration were meningitis (n = 4), septicemia (n = 2), pneumonia (n = 1), cellulitis (n = 1), urinary tract infection (n = 3), fever of unknown origin treated with antibiotics (n = 4), postoperative anemia requiring blood transfusion(s) (n = 2) and hyperglycaemia requiring insulin therapy (n = 2)
Summary
Tumors in the sellar or suprasellar region account for approximately 10% of all pediatric brain tumors [1]. Craniopharyngiomas account for the majority of sellar tumors in children, representing 1.2–4% of all pediatric intracranial tumors [2, 3]. CDI in the postoperative period may present with a triphasic response in the sodium and fluid balance [CDI, followed by the syndrome of inappropriate ADH secretion (SIADH), followed again by CDI]. This triphasic response may be explained by an axonic shock and instability of the posterior pituitary to secrete ADH, followed by leakage of ADH from the distorted neurons.
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