Predictors and Rates of Delayed Symptomatic Hyponatremia after Transsphenoidal Surgery: A Systemastic Review

Coté, David J.; Alzarea, Abdulaziz Ibrahim; Acosta, Michael; Hulou, Mohamed Maher; Huang, Kevin T.; Almutairi, H.; Alharbi, Ahmad; Zaidi, Hasan A.; Algrani, Majed; Alatawi, Ahmed D.; Mekary, Rania A.; Smith, Timothy R.

doi:10.1016/j.wneu.2016.01.022

Cited by 71 publications

(50 citation statements)

References 14 publications

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“…Transient DI typically presents within 24 to 48 hours after surgery with polyuria and generally resolves around postoperative days 3 to 5. Several large endoscopic series report the incidence of transient DI ranging from 4.6% to 8.7% . Furthermore, recent studies comparing endoscopic and microscopic transsphenoidal adenoma resection indicate a decreased incidence of DI in patients undergoing endoscopic resection of pituitary adenomas (4.6% vs 38.5%) .…”

Section: Intradural Tumorsmentioning

confidence: 99%

“…Such hyponatremia can be severe with serum sodium levels decreasing rapidly to <120 mmol/L. Delayed hyponatremia is a common cause of readmission after pituitary adenoma surgery and can present as nausea, emesis, headache, confusion, seizures, and even death . The pathophysiology of delayed hyponatremia remains controversial and may in fact result from more than 1 mechanism, including either an excessive release of antidiuretic hormone from the posterior pituitary gland (syndrome of inappropriate antidiuretic hormone [SIADH]), or from an increased secretion of natriuretic factors leading to an increased excretion of urinary sodium (cerebral salt wasting [CSW]) …”

Section: Intradural Tumorsmentioning

confidence: 99%

“…Regardless of etiology, the incidence of delayed hyponatremia ranges from 4% to 20% in both endoscopic and microscopic transsphenoidal series. Risk factors include older age, greater tumor size, presumably leading to more effacement and manipulation of the neurohypophysis, as well as ACTH‐producing adenomas . However, a multivariate analysis of over 1000 pituitary surgeries indicated only preoperative hypopituitarism predicted postoperative hyponatremia …”

Section: Intradural Tumorsmentioning

confidence: 99%

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ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

151

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Section: Intradural Tumorsmentioning

confidence: 99%

Section: Intradural Tumorsmentioning

confidence: 99%

Section: Intradural Tumorsmentioning

confidence: 99%

See 1 more Smart Citation

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

151

279

View full text Add to dashboard Cite

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“…A common complication of transsphenoidal surgery (TSS) for pituitary adenomas is a disturbance in water and electrolyte balance with hyponatraemia reported as one of the most frequent post-operative complications and reasons for readmission (1,2,3). A systematic review, including 2974 patients from 10 case series, found that the frequency of reported delayed hyponatraemia ranged from 3.6% to 19.8% (1). In a large study extracting 1240 cases from the American College of Surgeons NSQIP database, the 30-day readmission rate was 8.9%, and 29.5% of these were due to hyponatraemia (2).…”

Section: Introductionmentioning

confidence: 99%

Transsphenoidal surgery for pituitary tumours: frequency and predictors of delayed hyponatraemia and their relationship to early readmission

Krogh

Kistorp

Jafar-Mohammadi

et al. 2018

European Journal of Endocrinology

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Hyponatraemia occurred in 25% of readmissions; however, we did not identify any predictive variable for readmission with hyponatraemia. One week post surgery, 8.9% had hyponatraemia. Tumours pressing on the optic chiasm as well as a fall in sodium levels on the first post-operative day were associated with an increased risk of hyponatraemia one week post surgery. We suggest that a day 7 serum sodium <130 nmol/L should lead to concern and the provision of patient advice.

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“…Aquaporin 1 deficient mice showed a 5-fold reduction in CSF secretion and consequently intracranial pressure lowering [32]. A possible underlying mechanism of Aquaporin 1 overexpression leading to enhanced CSF formation and subsequent pressure elevation could be the systemic hyponatremic state caused by steroid deficiency after successful treatment of CD [33,34]. Another possible mechanism contributing to intracranial pressure elevation following biochemical remission of CD is the potential of partial recovery of cerebral atrophy associated with chronic hypercortisolism.…”

Section: Development Of Health-related Quality Of Life Following Surgmentioning

confidence: 99%

Prevalence of Signs and Symptoms of Pseudotumor Cerebri Syndrome Before and After Transsphenoidal Surgery for Cushing’s Disease – A Prospective Consecutive Case Series

Huckhagel

Flitsch

Rotermund

et al. 2020

Exp Clin Endocrinol Diabetes

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Introduction Pseudotumor cerebri syndrome (PTCS) has anecdotally been described after successful treatment of Cushing’s disease (CD), but the prevalence following transsphenoidal surgery has not been determined so far in a prospective study. Patients and Methods 41 consecutive adult CD patients were prospectively screened for signs and symptoms of PTCS, headache-related impairment, and ophthalmological features associated with intracranial pressure elevation before surgery and at follow-up (mean 4 months). Results Biochemical remission was achieved in 36 of 41 (87.8%) patients after surgery. The most frequent preoperative complaints were visual acuity impairment (19 cases; 46.3%), headache (13 cases; 31.7%), and ear noise (9 cases; 22.0%). A significant reduction of visual disturbances was seen at follow-up. Overall, CD patients presented with fairly low headache-related emotional and functional restrictions before and after surgery. One of 34 (2.9%) patients with sufficient ophthalmological follow-up showed new-onset papilledema combined with temporary worsening of visual acuity and scotoma. Conclusion Our results suggest a very low frequency of signs and symptoms of PTCS after surgical treatment for CD in adults. This estimate is in line with previous outcomes from retrospective pediatric CD series. Further large-scale studies are needed to determine the actual prevalence of this condition following biochemical remission of CD.

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Predictors and Rates of Delayed Symptomatic Hyponatremia after Transsphenoidal Surgery: A Systemastic Review

Cited by 71 publications

References 14 publications

ICAR: endoscopic skull‐base surgery

ICAR: endoscopic skull‐base surgery

Transsphenoidal surgery for pituitary tumours: frequency and predictors of delayed hyponatraemia and their relationship to early readmission

Prevalence of Signs and Symptoms of Pseudotumor Cerebri Syndrome Before and After Transsphenoidal Surgery for Cushing’s Disease – A Prospective Consecutive Case Series

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