Abstract:
PURPOSE:Severe 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. METHODS:A 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. RESULTS:Postoperative 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). CONCLUSION:Postoperative 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.
journal_name
Pituitaryjournal_title
Pituitaryauthors
Kruis RWJ,Schouten-van Meeteren AYN,Finken MJJ,Oostdijk W,van Trotsenburg ASP,Boot AM,Claahsen-van der Grinten HL,van Lindert EJ,Han KS,Hoving EW,Michiels EMC,van Santen HMdoi
10.1007/s11102-018-0886-2subject
Has Abstractpub_date
2018-08-01 00:00:00pages
384-392issue
4eissn
1386-341Xissn
1573-7403pii
10.1007/s11102-018-0886-2journal_volume
21pub_type
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