Diabetes Insipidus After Endoscopic Transsphenoidal Surgery

Abstract

BACKGROUND Diabetes insipidus (DI) is a recognized transient or permanent complication following transsphenoidal surgery (TSS) for pituitary tumors. OBJECTIVE To describe significant experience with the incidence of DI after TSS, identifying predictive characteristics and describing our diagnosis and management of postoperative DI. METHODS A retrospective analysis was performed of 700 patients who underwent endoscopic TSS for resection of pituitary adenoma (PA), Rathke cleft cyst (RCC), or craniopharyngioma. Inclusion criteria included at least 1 wk of follow-up for diagnosis of postoperative DI. Permanent DI was defined as DI symptoms and/or need for desmopressin more than 1 yr postoperatively. All patients with at least 1 yr of follow-up (n = 345) were included in analyses of permanent DI. Multivariable logistic regression models were constructed to identify predictors of transient or permanent postoperative DI. RESULTS The overall rate of any postoperative DI was 14.7% (103/700). Permanent DI developed in 4.6% (16/345). The median follow-up was 10.7 mo (range: 0.2-136.6). Compared to patients with PA, patients with RCC (odds ratio [OR] = 2.2, 95% CI: 1.2-3.9; P = .009) and craniopharyngioma (OR = 7.0, 95% CI: 2.9-16.9; P ≤ .001) were more likely to develop postoperative DI. Furthermore, patients with RCC (OR = 6.1, 95% CI: 1.8-20.6; P = .004) or craniopharyngioma (OR = 18.8, 95% CI: 4.9-72.6; P ≤ .001) were more likely to develop permanent DI compared to those with PA. CONCLUSION Although transient DI is a relatively common complication of endoscopic and microscopic TSS, permanent DI is much less frequent. The underlying pathology is an important predictor of both occurrence and permanency of postoperative DI.

Clinical Outcomes of Transcranial and Endoscopic Endonasal Surgery for Craniopharyngiomas: A Single-Institution Experience

“…The results are comparable to other studies that reported CSF leak rates of less than 10% ( 40 , 41 ). A higher body mass index (BMI) and perioperative hydrocephalus may have an impact on the occurrence of CSF leakage ( 42 ).…”

Predicting the Need for Desmopressin Treatment During Inpatient and After Discharge Following Endoscopic Sellar Surgery

“…External validations are necessary to assess the capability to generalize a prediction model on other similar populations (34). Although several predictive models were proposed in the literature to stratify patients following sellar surgery, external validations were not performed (3,(7)(8)(9)(30)(31)(32). In the present study, a second cohort from 2020-2021 was used to externally validate the potential predictors identified from multivariate analysis performed in the 2016-2019 cohort.…”

“…The degree of damage correlates with the severity of vasopressin deficits and produces a spectrum of water and electrolyte imbalance ( 6 ). Although the incidence rate of permanent DI has decreased in modern practice, transient postoperative DI remains common ( 2 , 7 , 8 ). In some patients, the duration of transient postoperative DI can last for weeks to months and necessitate desmopressin replacement ( 5 , 7 ).…”

Optimizing pre-, intra-, and postoperative management of patients with sellar pathology undergoing transsphenoidal surgery

“…We recently reported an overall rate of DI after transsphenoidal surgery of 14.7% and a rate of permanent DI of 4.6%. 7 Postoperative CSF leak after transsphenoidal surgery can occasionally be treated conservatively with lumbar drainage, but it often requires reoperation for repair of the skull base defect. 17,38 Previously identified predictors of CSF leak post-transsphenoidal surgery include body mass index, identification of intraoperative leak, and pre- operative hydrocephalus, with rates ranging from 2.6% to 11%.…”

“…Patients require careful monitoring for these problems, and institutional protocols in the perioperative period can help limit their occurrence. 6,7 Many of these patients also require longterm follow-up for management of endocrinological and neurosurgical issues, but few studies have discussed the optimum strategy for postoperative management in this patient population. 15 We aimed to describe the experience of our institution in the pre-, intra-, and postoperative management of a broad range of patients with sellar pathology who undergo transsphenoidal surgery.…”