1. Management and consequences of postoperative fluctuations in plasma sodium concentration after pediatric brain tumor surgery in the sellar region
- Author
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H. M. van Santen, Wilma Oostdijk, Annemieke M. Boot, Eelco W Hoving, E. M. C. Michiels, K S Han, Martijn J. J. Finken, H.L. Claahsen-van der Grinten, A. Y. N. Schouten-van Meeteren, A. S. P. van Trotsenburg, R. W. J. Kruis, E. J. van Lindert, Pediatric surgery, Amsterdam Reproduction & Development (AR&D), AGEM - Endocrinology, metabolism and nutrition, Other Research, CCA - Cancer Treatment and quality of life, Paediatric Oncology, CCA - Cancer Treatment and Quality of Life, Amsterdam Neuroscience - Cellular & Molecular Mechanisms, Paediatric Endocrinology, Faculteit Medische Wetenschappen/UMCG, and Pediatrics
- Subjects
Male ,Plasma sodium ,genetic structures ,medicine.medical_treatment ,Endocrinology, Diabetes and Metabolism ,CHILDHOOD ,0302 clinical medicine ,Endocrinology ,Brain neoplasm ,WATER ,Postoperative Period ,Child ,Neurological consequence ,Brain Neoplasms ,Vascular damage Radboud Institute for Molecular Life Sciences [Radboudumc 16] ,Craniopharyngioma ,Diabetes and Metabolism ,Child, Preschool ,SURGICAL-TREATMENT ,Female ,Plasma sodium concentration ,CRANIOPHARYNGIOMA ,ELECTROLYTE ,medicine.medical_specialty ,Adolescent ,DISORDERS ,PITUITARY-TUMORS ,Diabetes insipidus ,030209 endocrinology & metabolism ,Article ,03 medical and health sciences ,medicine ,Humans ,Retrospective Studies ,Transsphenoidal surgery ,Neurological effect ,business.industry ,Pituitary tumors ,Sodium ,Infant, Newborn ,Infant ,Retrospective cohort study ,medicine.disease ,Surgery ,Diabetes Insipidus, Neurogenic ,Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10] ,DIABETES-INSIPIDUS ,Pediatric Brain Tumor ,TRANSSPHENOIDAL SURGERY ,business ,Complication ,FOLLOW-UP ,030217 neurology & neurosurgery - Abstract
Contains fulltext : 193237.pdf (Publisher’s version ) (Open Access) 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.
- Published
- 2018
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