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Hyponatremia after craniotomy in children: a single-institution review

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Abstract

Purpose

Hyponatremia after craniotomy can be associated with increased morbidity. However, the incidence of and factors associated with post-craniotomy hyponatremia in children are not known.

Methods

We performed a retrospective cohort study of patients aged 0–21 years who underwent craniotomy in 2017–2019 at a single center to determine the incidence of and to identify risk factors for hyponatremia after craniotomy. Indications for craniotomy included tumors (excluding craniopharyngioma), epilepsy, intracranial infection, trauma, craniofacial, suboccipital decompression for the treatment of Chiari malformation, and cerebrovascular disease. Hyponatremia was defined as a serum sodium level ≤ 135 mEq/L any time during the postoperative hospital stay. Statistical significance was defined a priori at p < 0.05.

Results

Postoperative hyponatremia occurred in 61 (25%) of 240 children. On univariate analysis, hyponatremia was associated with younger age (8.5 vs 6.3 years, p = 0.01), use of preoperative anti-epileptic drugs (p = 0.02), need for blood transfusion (p = 0.02), government/private insurance (p = 0.04), and pre-existing hydrocephalus, defined as the requirement for permanent cerebrospinal fluid (CSF) diversion (p = 0.04). On multivariate analysis, only hydrocephalus (OR 2.95, 95% CI 1.03–8.40) remained statistically significant. Hyponatremia most occurred on the first postoperative day, with normonatremia achieved in a median of 14 (IQR 9.8–24.3) h. Hyponatremia was significantly associated with longer length of stay (median 8 vs 3 days, p < 0.01).

Conclusion

Hyponatremia was present in 25% of children after craniotomy. Preoperative hydrocephalus as an independent risk factor for hyponatremia after craniotomy.

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Data availability

Data will be made available after contacting the corresponding author. The appropriate regulatory steps have been taken.

Abbreviations

BUN:

Blood urea nitrogen

CSW:

Cerebral salt wasting

CSF:

Cerebrospinal fluid

EDAS:

Encephaloduraateriosynagiosis

ETV:

Endoscopic third ventriculostomy

EVD:

External ventricular drain

ICU:

Intensive care unit

IQR:

Inter-quantile range

OR:

Odds ratio

SIADH:

Syndrome of Inappropriate secretion of Anti-Diuretic Hormone

WHO:

World Health Organization

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Acknowledgements

The authors would like the thank the Faculty and Staff within the Division of Pediatric Neurosurgery at Children’s of Alabama for their support of this work.

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Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Children’s of Alabama, Birmingham, AL, USA

    Olivia Keating, Andrew T. Hale, Anastasia A. Smith, Victoria Jimenez & Brandon G. Rocque

  2. Division of Pediatric Endocrinology, University of Alabama at Birmingham, Children’s of Alabama, Birmingham, AL, USA

    Ambika P. Ashraf

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  1. Olivia Keating
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  2. Andrew T. Hale
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  4. Victoria Jimenez
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Contributions

Olivia Keating, Andrew T. Hale, Anastasia A. Smith, and Victoria Jimenez collected data. Olivia Keating, Andrew T. Hale, and Brandon G. Rocque performed statistical analysis. Olivia Keating wrote the first draft of the manuscript. The final manuscript was approved by all authors.

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Correspondence to Andrew T. Hale.

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The authors declare that no competing interests exist as related to this study.

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Keating, O., Hale, A.T., Smith, A.A. et al. Hyponatremia after craniotomy in children: a single-institution review. Childs Nerv Syst 39, 617–623 (2023). https://doi.org/10.1007/s00381-022-05729-8

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  • DOI: https://doi.org/10.1007/s00381-022-05729-8

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