Skip to main content

Advertisement

SpringerLink
Log in

Evaluation of postoperative fluctuations in plasma sodium concentration and triphasic response after pediatric craniopharyngioma resection: A French cohort study

  • Research
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Introduction

Disturbances in plasma sodium levels are a major complication following recent resections of craniopharyngiomas in children. They must be properly managed to avoid neurological sequelae. We aimed to describe the variations and characteristics of postoperative natremia in children who had undergone a first craniopharyngioma resection with a particular focus on the frequency of triphasic syndrome in these patients.

Methods

Paediatric patients with craniopharyngiomas who underwent a first surgical resection in the neurosurgery department of the Hôpital Femme Mère Enfant (Lyon, France) between January 2010 and September 2021 were included in the present study and the medical records were analysed retrospectively.

Results

A total of 26 patients were included. Of these, 17 (65.4%) had a postoperative course characterised by the occurrence of both initial diabetes insipidus (DI) and hyponatremia a few days later. Eight patients (30.8%) presented then with isolated and persistent DI. Patients with the triphasic syndrome had a significantly higher grade of Puget classification on MRI (1 and 2), compared to the other patients.

Conclusion

Dysnatremia is common after craniopharyngioma resections in children. This immediate postoperative complication is particularly difficult to manage and requires rapid diagnosis and prompt initiation of medical treatment to minimize fluctuations in sodium levels and avoid neurological sequelae.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

No datasets were generated or analysed during the current study.

References

  1. Müller HL, Merchant TE, Warmuth-Metz M, Martinez-Barbera JP, Puget S, Craniopharyngioma (2019) Nat Rev Dis Primers 5(1):75

    Article  PubMed  Google Scholar 

  2. Rosemberg S, Fujiwara D (2005) Epidemiology of pediatric tumors of the nervous system according to the WHO 2000 classification: a report of 1,195 cases from a single institution. Childs Nerv Syst 21(11):940–944

    Article  PubMed  Google Scholar 

  3. Hoffmann A, Boekhoff S, Gebhardt U, Sterkenburg A, Daubenbüchel AM, Eveslage M et al (2015) History before diagnosis in childhood craniopharyngioma: associations with initial presentation and long-term prognosis. Eur J Endocrinol 173(6):853–862

    Article  CAS  PubMed  Google Scholar 

  4. Larijani B, Bastanhagh MH, Pajouhi M, Kargar Shadab F, Vasigh A, Aghakhani S (2004) Presentation and outcome of 93 cases of craniopharyngioma. Eur J Cancer Care (Engl) 13(1):11–15

    Article  CAS  PubMed  Google Scholar 

  5. A C AR, C AC, Ml G (2006) Neuroimaging of pediatric craniopharyngiomas: a pictorial essay. J Pediatr Endocrinol Metab 19(Suppl 1):299–319

    Google Scholar 

  6. Drapeau A, Walz PC, Eide JG, Rugino AJ, Shaikhouni A, Mohyeldin A et al (2019) Pediatric craniopharyngioma. Childs Nerv Syst 35(11):2133–2145

    Article  PubMed  Google Scholar 

  7. Puget S, Garnett M, Wray A, Grill J, Habrand JL, Bodaert N et al (2007) Pediatric craniopharyngiomas: classification and treatment according to the degree of hypothalamic involvement. J Neurosurg 106(1 Suppl):3–12

    PubMed  Google Scholar 

  8. Ciurea AV, Saceleanu V, Mohan A, Moreanu MS, Toader C (2020) Craniopharyngiomas in children - experience of consecutive 152 operated cases. Acta Endocrinol (Buchar) 16(1):103–109

    Article  CAS  PubMed  Google Scholar 

  9. Hannon MJ, Thompson CJ (2019) Hyponatremia in neurosurgical patients. Front Horm Res 52:143–160

    Article  CAS  PubMed  Google Scholar 

  10. Smith D, Finucane F, Phillips J, Baylis PH, Finucane J, Tormey W et al (2004) Abnormal regulation of thirst and vasopressin secretion following surgery for craniopharyngioma. Clin Endocrinol (Oxf) 61(2):273–279

    Article  CAS  PubMed  Google Scholar 

  11. Edate S, Albanese A (2015) Management of electrolyte and fluid disorders after brain surgery for pituitary/suprasellar tumours. Horm Res Paediatr 83(5):293–301

    Article  CAS  PubMed  Google Scholar 

  12. Water balance disorders after neurosurgery the triphasic response revisited - PubMed [Internet]. 2010 Feb;3(1):42-44. https://doi.org/10.1093/ndtplus/sfp117. Epub 2009 Aug 29. [cited 2022 May 17]. https://pubmed.ncbi.nlm.nih.gov/20090880/

  13. Finken MJJ, Zwaveling-Soonawala N, Walenkamp MJE, Vulsma T, van Trotsenburg ASP, Rotteveel J (2011) Frequent occurrence of the triphasic response (diabetes insipidus/hyponatremia/diabetes insipidus) after surgery for craniopharyngioma in childhood. HRP 76(1):22–26

    CAS  Google Scholar 

  14. Du C, Leng Y, Zhou Q, Xiao JX, Yuan XR, Yuan J (2022) Relationship between postoperative hypothalamic injury and water and sodium disturbance in patients with craniopharyngioma: a retrospective study of 178 cases. Front Endocrinol (Lausanne) 13:958295

    Article  PubMed  Google Scholar 

  15. Pratheesh R, Swallow DMA, Rajaratnam S, Jacob KS, Chacko G, Joseph M et al (2013) Incidence, predictors and early post-operative course of diabetes insipidus in paediatric craniopharygioma: a comparison with adults. Childs Nerv Syst 29(6):941–949

    Article  PubMed  Google Scholar 

  16. AFPA Association Française de Pédiatrie Ambulatoire [Internet]. Courbes AFPA- CRESS/Inserm -CompuGroup Medical 2018 non libres de droit [cited 2023 Jun 16]. Nouvelles courbes de croissance des filles françaises - AFPA. https://afpa.org/outil/courbes-de-croissance-filles-francaises/

  17. Ohmori K, Collins J, Fukushima T (2007) Craniopharyngiomas in children. Pediatr Neurosurg 43(4):265–278

    Article  PubMed  Google Scholar 

  18. Taylor M, Couto-Silva AC, Adan L, Trivin C, Sainte-Rose C, Zerah M et al (2012) Hypothalamic-pituitary lesions in pediatric patients: endocrine symptoms often precede neuro-ophthalmic presenting symptoms. J Pediatr 161(5):855–863

    Article  PubMed  Google Scholar 

  19. Christ-Crain M, Winzeler B, Refardt J (2021) Diagnosis and management of diabetes insipidus for the internist: an update. J Intern Med 290(1):73–87

    Article  CAS  PubMed  Google Scholar 

  20. Gürbüz F, Taştan M, Turan İ, Yüksel B (2019) Efficiency of single dose of tolvaptan treatment during the triphasic episode after surgery for craniopharyngioma. J Clin Res Pediatr Endocrinol 11(2):202–206

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kruis RWJ, Schouten-van Meeteren AYN, Finken MJJ, Oostdijk W, van Trotsenburg ASP, Boot AM et al (2018) Management and consequences of postoperative fluctuations in plasma sodium concentration after pediatric brain tumor surgery in the sellar region: a national cohort analysis. Pituitary 21(4):384–392

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Liu JK, Sevak IA, Carmel PW, Eloy JA (2016) Microscopic versus endoscopic approaches for craniopharyngiomas: choosing the optimal surgical corridor for maximizing extent of resection and complication avoidance using a personalized, tailored approach. Neurosurg Focus 41(6):E5

    Article  PubMed  Google Scholar 

  23. Paja M, Lucas T, García-Uría J, Salamé F, Barceló B, Estrada J (1995) Hypothalamic-pituitary dysfunction in patients with craniopharyngioma. Clin Endocrinol (Oxf) 42(5):467–473

    Article  CAS  PubMed  Google Scholar 

  24. Burke WT, Cote DJ, Penn DL, Iuliano S, McMillen K, Laws ER (2020) Diabetes insipidus after endoscopic transsphenoidal surgery. Neurosurgery 87(5):949–955

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Endocrinology and metabolism, Hospices Civils de Lyon, Woman Mother and Child Hospital, Bron, France

    Lucie Bazus, Kevin Perge & Carine Villanueva

  2. Department of Pediatrics, CHU Saint-Etienne, Saint-Etienne, France

    Lucie Bazus

  3. Claude Bernard University, Lyon 1, 8 Avenue Rockefeller, Lyon, 69008, France

    Kevin Perge & Sara Cabet

  4. Department of Neurosurgery, Hospices Civils de Lyon, Woman Mother and Child Hospital, Bron, France

    Carmine Mottolese

  5. Department of Pediatric and Fetal Imaging, Hospices Civils de Lyon, Woman Mother and Child Hospital, Bron, France

    Sara Cabet

Authors
  1. Lucie Bazus
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kevin Perge
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sara Cabet
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carmine Mottolese
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carine Villanueva
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

L.B., C.M. and C.V. were involved in the conception, design and conduct of the study and the analysis and interpretation of the results. L.B. wrote the first draft of the manuscript. K.P. was involved in the interpretation of the results and reviewed the early version of the manuscript. S.C. carried out the MRI proofreading. All authors contributed to discussion and reviewed the final version of the manuscript.

Corresponding author

Correspondence to Lucie Bazus.

Ethics declarations

Ethics approval and consent to participate

Approval was obtained from the ethics committee of Lyon Children Hospital of the hospital (CSE-HCL – IRB 00013204; No 21_641). In line with national legislation, parents of children have been informed of this retrospective study by mail and could refuse to participate.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bazus, L., Perge, K., Cabet, S. et al. Evaluation of postoperative fluctuations in plasma sodium concentration and triphasic response after pediatric craniopharyngioma resection: A French cohort study. Childs Nerv Syst (2024). https://doi.org/10.1007/s00381-024-06451-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00381-024-06451-3

Keywords

Search

Navigation