Management and consequences of postoperative fluctuations in plasma sodium concentration after pediatric brain tumor surgery in the sellar region: a national cohort analysis

R. W. J. Kruis, A. Y. N. Schouten-van Meeteren, M. J. J. Finken, W. Oostdijk, A. S. P. van Trotsenburg, A. M. Boot, H. L. Claahsen-van der Grinten, E. J. van Lindert, K. S. Han, E. W. Hoving, E. M. C. Michiels, H. M. van Santen

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Purpose: Severe fluctuations in plasma sodium concentration and plasma osmolarity, including central diabetes insipidus (CDI), may have significant influence on postoperative morbidity and mortality after pediatric brain tumor surgery.The aim of this study was to describe the frequency, severity and neurological consequences of these fluctuations in pediatric brain tumor survivors. Methods: A retrospective, multi-institutional chart review was conducted among all children who underwent brain tumor surgery in the sellar or suprasellar region in seven university hospitals in the Netherlands between January 2004 and December 2013. Results: Postoperative CDI was observed in 67.5% of 120 included children. Fluctuations of plasma sodium concentration ≥ 10 mmol/L/24 h during the first ten postoperative days were seen in 75.3% of patients with CDI, with a maximum delta of 46 mmol/L/24 h. When compared to patients without CDI, altered mental status occurred more frequently in patients with postoperative CDI (5.1 vs. 23.5% respectively, p = 0.009). Low plasma sodium concentration was related to altered mental status and the occurrence of seizures. Frequency and severity of fluctuations in plasma sodium concentration during the first ten postoperative days were significantly higher in patients with permanent CDI at last follow-up than in patients with transient CDI or without CDI (p = 0.007). Conclusion: Postoperative CDI is a common complication after pediatric brain tumor surgery in the sellar or suprasellar region. Extreme plasma sodium concentrations and large intra-day fluctuations still occur and seem to influence the postoperative neurological course. These results illustrate the need for intensive monitoring in a highly experienced center.
Original languageEnglish
Pages (from-to)384-392
JournalPituitary
Volume21
Issue number4
DOIs
Publication statusPublished - 2018

Cite this

Kruis, R. W. J. ; Schouten-van Meeteren, A. Y. N. ; Finken, M. J. J. ; Oostdijk, W. ; van Trotsenburg, A. S. P. ; Boot, A. M. ; Claahsen-van der Grinten, H. L. ; van Lindert, E. J. ; Han, K. S. ; Hoving, E. W. ; Michiels, E. M. C. ; van Santen, H. M. / Management and consequences of postoperative fluctuations in plasma sodium concentration after pediatric brain tumor surgery in the sellar region: a national cohort analysis. In: Pituitary. 2018 ; Vol. 21, No. 4. pp. 384-392.
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title = "Management and consequences of postoperative fluctuations in plasma sodium concentration after pediatric brain tumor surgery in the sellar region: a national cohort analysis",
abstract = "Purpose: Severe fluctuations in plasma sodium concentration and plasma osmolarity, including central diabetes insipidus (CDI), may have significant influence on postoperative morbidity and mortality after pediatric brain tumor surgery.The aim of this study was to describe the frequency, severity and neurological consequences of these fluctuations in pediatric brain tumor survivors. Methods: A retrospective, multi-institutional chart review was conducted among all children who underwent brain tumor surgery in the sellar or suprasellar region in seven university hospitals in the Netherlands between January 2004 and December 2013. Results: Postoperative CDI was observed in 67.5{\%} of 120 included children. Fluctuations of plasma sodium concentration ≥ 10 mmol/L/24 h during the first ten postoperative days were seen in 75.3{\%} of patients with CDI, with a maximum delta of 46 mmol/L/24 h. When compared to patients without CDI, altered mental status occurred more frequently in patients with postoperative CDI (5.1 vs. 23.5{\%} respectively, p = 0.009). Low plasma sodium concentration was related to altered mental status and the occurrence of seizures. Frequency and severity of fluctuations in plasma sodium concentration during the first ten postoperative days were significantly higher in patients with permanent CDI at last follow-up than in patients with transient CDI or without CDI (p = 0.007). Conclusion: Postoperative CDI is a common complication after pediatric brain tumor surgery in the sellar or suprasellar region. Extreme plasma sodium concentrations and large intra-day fluctuations still occur and seem to influence the postoperative neurological course. These results illustrate the need for intensive monitoring in a highly experienced center.",
author = "Kruis, {R. W. J.} and {Schouten-van Meeteren}, {A. Y. N.} and Finken, {M. J. J.} and W. Oostdijk and {van Trotsenburg}, {A. S. P.} and Boot, {A. M.} and {Claahsen-van der Grinten}, {H. L.} and {van Lindert}, {E. J.} and Han, {K. S.} and Hoving, {E. W.} and Michiels, {E. M. C.} and {van Santen}, {H. M.}",
year = "2018",
doi = "10.1007/s11102-018-0886-2",
language = "English",
volume = "21",
pages = "384--392",
journal = "Pituitary",
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Kruis, RWJ, Schouten-van Meeteren, AYN, Finken, MJJ, Oostdijk, W, van Trotsenburg, ASP, Boot, AM, Claahsen-van der Grinten, HL, van Lindert, EJ, Han, KS, Hoving, EW, Michiels, EMC & van Santen, HM 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, vol. 21, no. 4, pp. 384-392. https://doi.org/10.1007/s11102-018-0886-2

Management and consequences of postoperative fluctuations in plasma sodium concentration after pediatric brain tumor surgery in the sellar region: a national cohort analysis. / Kruis, R. W. J.; Schouten-van Meeteren, A. Y. N.; Finken, M. J. J.; Oostdijk, W.; van Trotsenburg, A. S. P.; Boot, A. M.; Claahsen-van der Grinten, H. L.; van Lindert, E. J.; Han, K. S.; Hoving, E. W.; Michiels, E. M. C.; van Santen, H. M.

In: Pituitary, Vol. 21, No. 4, 2018, p. 384-392.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Management and consequences of postoperative fluctuations in plasma sodium concentration after pediatric brain tumor surgery in the sellar region: a national cohort analysis

AU - Kruis, R. W. J.

AU - Schouten-van Meeteren, A. Y. N.

AU - Finken, M. J. J.

AU - Oostdijk, W.

AU - van Trotsenburg, A. S. P.

AU - Boot, A. M.

AU - Claahsen-van der Grinten, H. L.

AU - van Lindert, E. J.

AU - Han, K. S.

AU - Hoving, E. W.

AU - Michiels, E. M. C.

AU - van Santen, H. M.

PY - 2018

Y1 - 2018

N2 - Purpose: Severe fluctuations in plasma sodium concentration and plasma osmolarity, including central diabetes insipidus (CDI), may have significant influence on postoperative morbidity and mortality after pediatric brain tumor surgery.The aim of this study was to describe the frequency, severity and neurological consequences of these fluctuations in pediatric brain tumor survivors. Methods: A retrospective, multi-institutional chart review was conducted among all children who underwent brain tumor surgery in the sellar or suprasellar region in seven university hospitals in the Netherlands between January 2004 and December 2013. Results: Postoperative CDI was observed in 67.5% of 120 included children. Fluctuations of plasma sodium concentration ≥ 10 mmol/L/24 h during the first ten postoperative days were seen in 75.3% of patients with CDI, with a maximum delta of 46 mmol/L/24 h. When compared to patients without CDI, altered mental status occurred more frequently in patients with postoperative CDI (5.1 vs. 23.5% respectively, p = 0.009). Low plasma sodium concentration was related to altered mental status and the occurrence of seizures. Frequency and severity of fluctuations in plasma sodium concentration during the first ten postoperative days were significantly higher in patients with permanent CDI at last follow-up than in patients with transient CDI or without CDI (p = 0.007). Conclusion: Postoperative CDI is a common complication after pediatric brain tumor surgery in the sellar or suprasellar region. Extreme plasma sodium concentrations and large intra-day fluctuations still occur and seem to influence the postoperative neurological course. These results illustrate the need for intensive monitoring in a highly experienced center.

AB - Purpose: Severe fluctuations in plasma sodium concentration and plasma osmolarity, including central diabetes insipidus (CDI), may have significant influence on postoperative morbidity and mortality after pediatric brain tumor surgery.The aim of this study was to describe the frequency, severity and neurological consequences of these fluctuations in pediatric brain tumor survivors. Methods: A retrospective, multi-institutional chart review was conducted among all children who underwent brain tumor surgery in the sellar or suprasellar region in seven university hospitals in the Netherlands between January 2004 and December 2013. Results: Postoperative CDI was observed in 67.5% of 120 included children. Fluctuations of plasma sodium concentration ≥ 10 mmol/L/24 h during the first ten postoperative days were seen in 75.3% of patients with CDI, with a maximum delta of 46 mmol/L/24 h. When compared to patients without CDI, altered mental status occurred more frequently in patients with postoperative CDI (5.1 vs. 23.5% respectively, p = 0.009). Low plasma sodium concentration was related to altered mental status and the occurrence of seizures. Frequency and severity of fluctuations in plasma sodium concentration during the first ten postoperative days were significantly higher in patients with permanent CDI at last follow-up than in patients with transient CDI or without CDI (p = 0.007). Conclusion: Postoperative CDI is a common complication after pediatric brain tumor surgery in the sellar or suprasellar region. Extreme plasma sodium concentrations and large intra-day fluctuations still occur and seem to influence the postoperative neurological course. These results illustrate the need for intensive monitoring in a highly experienced center.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/29623580

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DO - 10.1007/s11102-018-0886-2

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JO - Pituitary

JF - Pituitary

SN - 1386-341X

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