Introduction: Diabetes Insipidus (DI) after endoscopic transnasal transsphenoidal surgery (ETSS) can lead to increased morbidity, longer hospital stays, and increased medication requirements. Predicting which patients are at risk for developing DI can help direct services to ensure adequate care and follow-up. Our objective of was to review our experience with ETSS and determine which variables can predict DI. This represents one of the largest North American series of this type.
Methods: We performed a retrospective review of a series of consecutive patients who had undergone ETSS for resection of sellar and parasellar lesions from 2006 to 2011. We examined patient and tumor characteristics and their relationship with developing DI.
Results: There were 186 patients total, mean age of 57 (range, 16-88). One-hundred-ten (59%) patients were female, 76(41%) were male. One-hundred-twenty-two (65%) patients had adenomas, 17(9%) had either Rathke’s cleft cyst (RCC) or craniopharyngioma. Overall 28(15%) patients developed DI requiring medication (14 permanent and 14 transient). Average tumor volume was 6.2cc (5.3cc in non-DI group vs. 11.2cc in DI group [p<0.05]). Average immediate post operative sodium was 144.7 mEq/L in the DI group vs. 139 mEq/L in the non-DI group (p<0.05). Thirty-percent of DI patients had either an RCC or craniopharyngioma vs. only 5% of the non-DI group. Twenty-percent of permanent DI patients had a CSF leak vs. 10% of patient without DI. Sixty-seven percent of DI patients had suprasellar extension compared to 11% in non-DI group.
Conclusions: Identifying perioperative risk factors for DI after ETSS will help physicians care for patients postoperatively. Pre-operative risk factors for the development of DI included histology, tumor size, and suprasellar extension. Immediate post-operative sodium was predictive for develop permanent DI. These finding are consistent with other reports from microscopic surgical series. These data can help plan treatment algorithms, ICU stays and increase vigilance in at risk patients
Patient Care: This will hopefully identify patients at risk for Diabetes Insipidus preoperatively. This can help in planning treatment algorithms, ICU stays and increase vigilance in high risk patients.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the important risk factors that may predict Diabetes Insipidus in a post operative setting after endoscopic transphenoidal surgery
2) Discuss, in small groups what steps can be taken to minimize this complication after surgery
3) Identify an effective treatment algorithm if/when this condition develops
References: 1)Berker M, Hazer DB, Yücel T, Gürlek A, Cila A, Aldur M, Onerci M, Complications of endoscopic surgery of the pituitary adenomas: analysis of 570 patients and review of the literature. Pituitary. 2011 Dec 8. [Epub ahead of print]
2)Hofstetter CP, Nanaszko MJ, Mubita LL, Tsiouris J, Anand VK, Schwartz TH. Volumetric classification of pituitary macroadenomas predicts outcome and morbidity following endoscopic endonasal transsphenoidal surgery. Pituitary. 2011 Oct 11. [Epub ahead of print]
3)Nemergut EC, Zuo Z, Jane JA Jr, Laws ER Jr., Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients. J Neurosurg. 2005 Sep;103(3):448-54.