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Incidence, predictors and early post-operative course of diabetes insipidus in paediatric craniopharygioma: a comparison with adults

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Abstract

Purpose

This study aims to determine the incidence, predictors, early post-operative course of diabetes insipidus (DI) in paediatric craniopharyngiomas(CP) and compare the findings with adults.

Methods

Retrospective analysis of clinical, biochemical, radiological and operative data for 102 consecutive CP surgeries (45 paediatric and 57 adult cases) was done. Bivariate and multivariate analyses were done to determine the predictors of DI. The incidence of the triphasic response and electrolyte abnormalities in the first post-operative week was compared between children and adults.

Results

Children had larger tumours and higher incidence of cystic tumours and hydrocephalus. Preoperative DI was close to 15 % in both the age groups. Radical/subtotal excision was achieved in 58 % of children and 53 % of adults. The incidence of post-operative DI was 80 % and 63 % in children and adults, respectively. Children had significantly higher incidence of permanent DI (55.6 %). Radical excision in children (p = 0.000); previous tumour surgery (p = 0.014) and new onset hypopituitarism (p = 0.019) in adults were associated with permanent DI. The triphasic response (23 %), wide intra-day serum sodium fluctuations and hyponatraemia were more common in children.

Conclusions

Post-operative DI is a frequent and significant cause of morbidity in children undergoing surgery for CP. Children have a higher incidence of permanent DI. Radical excision is a predictor of permanent DI in children, whereas previous tumour excision and new onset hypopituitarism were predictors of permanent DI among adults. The management of post-operative DI is more difficult in children and the treating physician needs to be alert to detect the triphasic response.

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References

  1. Müller HL (2010) Childhood craniopharyngioma—current concepts in diagnosis, therapy and follow-up. Nat Rev Endocrinol 6:609–618

    Article  PubMed  Google Scholar 

  2. Karavitaki N, Cudlip S, Adams CBT, Wass JAH (2006) Craniopharyngiomas. Endocr Rev 27:371–397

    Article  PubMed  Google Scholar 

  3. Honegger J, Buchfelder M, Fahlbusch R (1999) Surgical treatment of craniopharyngiomas: endocrinological results. J Neurosurg 90:251–257

    Article  PubMed  CAS  Google Scholar 

  4. Karavitaki N, Brufani C, Warner JT, Adams CBT, Richards P, Ansorge O, Shine B, Turner HE, Wass JAH (2005) Craniopharyngiomas in children and adults: systematic analysis of 121 cases with long-term follow-up. Clin Endocrinol (Oxf) 62:397–409

    Article  CAS  Google Scholar 

  5. Lehrnbecher T, Müller-Scholden J, Danhauser-Leistner I, Sörensen N, von Stockhausen HB (1998) Perioperative fluid and electrolyte management in children undergoing surgery for craniopharyngioma. A 10-year experience in a single institution. Childs Nerv Syst 14:276–279

    Article  PubMed  CAS  Google Scholar 

  6. Wang L, Zhao S, Zhang W, Zhang M (2006) Treatment of alternated water-electrolyte balance and endocrine status after removal of craniopharyngioma in adults. Chin Med J 119:1348–1352

    PubMed  Google Scholar 

  7. Yaşargil MG, Curcic M, Kis M, Siegenthaler G, Teddy PJ, Roth P (1990) Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients. J Neurosurg 73:3–11

    Article  PubMed  Google Scholar 

  8. Rushing EJ, Giangaspero F, Paulus W, Burger PC (2007) Craniopharyngioma. In: Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (eds) WHO Classification of Tumours of the Central Nervous System, 4th edn. IARC Press, Lyon, pp 238–240

    Google Scholar 

  9. Lyen KR, Grant DB (1982) Endocrine function, morbidity, and mortality after surgery for craniopharyngioma. Arch Dis Child 57:837–841

    Article  PubMed  CAS  Google Scholar 

  10. DeVile CJ, Grant DB, Hayward RD, Stanhope R (1996) Growth and endocrine sequelae of craniopharyngioma. Arch Dis Child 75:108–114

    Article  PubMed  CAS  Google Scholar 

  11. Sorva R, Heiskanen O, Perheentupa J (1988) Craniopharyngioma surgery in children: endocrine and visual outcome. Childs Nerv Syst 4:97–99

    PubMed  CAS  Google Scholar 

  12. Choux M, Lena G, Genitori L (1991) Craniopharyngioma in children. 41st annual congress of the French Society of Neurosurgery. Lisbon, Portugal, 4–7 June 1991. Neurochirurgie 37(Suppl 1):1–174

    Google Scholar 

  13. Hoffman HJ, De Silva M, Humphreys RP, Drake JM, Smith ML, Blaser SI (1992) Aggressive surgical management of craniopharyngiomas in children. J Neurosurg 76:47–52

    Article  PubMed  CAS  Google Scholar 

  14. Weiner HL, Wisoff JH, Rosenberg ME, Kupersmith MJ, Cohen H, Zagzag D, Shiminski-Maher T, Flamm ES, Epstein FJ, Miller DC (1994) Craniopharyngiomas: a clinicopathological analysis of factors predictive of recurrence and functional outcome. Neurosurgery 35:1001–1010, discussion 1010–1011

    Article  PubMed  CAS  Google Scholar 

  15. Caldarelli M, Massimi L, Tamburrini G, Cappa M, Di Rocco C (2005) Long-term results of the surgical treatment of craniopharyngioma: the experience at the Policlinico Gemelli, Catholic University, Rome. Childs Nerv Syst 21:747–757

    Article  PubMed  CAS  Google Scholar 

  16. Elliott RE, Jane JA Jr, Wisoff JH (2011) Surgical management of craniopharyngiomas in children: meta-analysis and comparison of transcranial and transsphenoidal approaches. Neurosurgery 69:630–643, discussion 643

    Article  PubMed  Google Scholar 

  17. Mortini P, Losa M, Pozzobon G, Barzaghi R, Riva M, Acerno S, Angius D, Weber G, Chiumello G, Giovanelli M (2011) Neurosurgical treatment of craniopharyngioma in adults and children: early and long-term results in a large case series. J Neurosurg 114:1350–1359

    PubMed  Google Scholar 

  18. Sughrue ME, Yang I, Kane AJ, Fang S, Clark AJ, Aranda D, Barani IJ, Parsa AT (2011) Endocrinologic, neurologic, and visual morbidity after treatment for craniopharyngioma. J Neurooncol 101:463–476

    Article  PubMed  Google Scholar 

  19. Zhou Z, Shi X (2004) Changes of hypothalamus-pituitary hormones in patients after total removal of craniopharyngiomas. Chin Med J 117:357–360

    PubMed  CAS  Google Scholar 

  20. Jung T-Y, Jung S, Choi J-E, Moon K-S, Kim I-Y, Kang S-S (2009) Adult craniopharyngiomas: surgical results with a special focus on endocrinological outcomes and recurrence according to pituitary stalk preservation. J Neurosurg 111:572–577

    Article  PubMed  Google Scholar 

  21. Nishizawa S, Ohta S, Oki Y (2006) Spontaneous resolution of diabetes insipidus after pituitary stalk sectioning during surgery for large craniopharyngioma. Endocrinological evaluation and clinical implications for surgical strategy. Neurol Med Chir (Tokyo) 46:126–134, discussion 134–135

    Article  Google Scholar 

  22. Jung T-Y, Jung S, Moon K-S, Kim I-Y, Kang S-S, Kim J-H (2010) Endocrinological outcomes of pediatric craniopharyngiomas with anatomical pituitary stalk preservation: preliminary study. Pediatr Neurosurg 46:205–212

    Article  PubMed  Google Scholar 

  23. Hollinshead WH (1964) The interphase of diabetes insipidus. Mayo Clin Proc 39:92–100

    PubMed  CAS  Google Scholar 

  24. Verbalis JG, Robinson AG, Moses AM (1984) Postoperative and post-traumatic diabetes insipidus. In: Czernichow P, Robinson AG (eds) Diabetes Insipidus in Man. Karger, Basel, pp 247–265

    Google Scholar 

  25. De Vile CJ, Grant DB, Kendall BE, Neville BG, Stanhope R, Watkins KE, Hayward RD (1996) Management of childhood craniopharyngioma: can the morbidity of radical surgery be predicted? J Neurosurg 85:73–81

    Article  PubMed  Google Scholar 

  26. 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. Horm Res Paediatr 76:22–26

    Article  PubMed  CAS  Google Scholar 

  27. Wise-Faberowski L, Soriano SG, Ferrari L, McManus ML, Wolfsdorf JI, Majzoub J, Scott RM, Truog R, Rockoff MA (2004) Perioperative management of diabetes insipidus in children. J Neurosurg Anesthesiol 16:220–225

    Article  PubMed  Google Scholar 

  28. Elliott RE, Wisoff JH (2010) Surgical management of giant pediatric craniopharyngiomas. J Neurosurg Pediatr 6:403–416

    Article  PubMed  Google Scholar 

  29. Jane JA Jr, Prevedello DM, Alden TD, Laws ER Jr (2010) The transsphenoidal resection of pediatric craniopharyngiomas: a case series. J Neurosurg Pediatr 5:49–60

    Article  PubMed  Google Scholar 

  30. Yang I, Sughrue ME, Rutkowski MJ, Kaur R, Ivan ME, Aranda D, Barani IJ, Parsa AT (2010) Craniopharyngioma: a comparison of tumor control with various treatment strategies. Neurosurg Focus 28:E5

    Article  PubMed  Google Scholar 

  31. Fischer EG, Welch K, Shillito J Jr, Winston KR, Tarbell NJ (1990) Craniopharyngiomas in children. Long-term effects of conservative surgical procedures combined with radiation therapy. J Neurosurg 73:534–540

    Article  PubMed  CAS  Google Scholar 

  32. Puget S, Garnett M, Wray A, Grill J, Habrand J-L, Bodaert N, Zerah M, Bezerra M, Renier D, Pierre-Kahn A et al (2007) Pediatric craniopharyngiomas: classification and treatment according to the degree of hypothalamic involvement. J Neurosurg 106:3–12

    PubMed  Google Scholar 

  33. Hofmann BM, Nimsky C, Fahlbusch R (2011) Benefit of 1.5-T intraoperative MR imaging in the surgical treatment of craniopharyngiomas. Acta Neurochir (Wien) 153:1377–1390, discussion 1390

    Article  Google Scholar 

Download references

Ethical standards

The authors declare that there were no ethical issues in this retrospective study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College, Vellore, 632004, Tamil Nadu, India

    Ravindran Pratheesh, Mathew Joseph & Ari G. Chacko

  2. Section of Neuropathology, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India

    Geeta Chacko

  3. Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India

    Simon Rajaratnam

  4. Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India

    K. S. Jacob

  5. University of Aberdeen, Aberdeen, Scotland, UK

    Diane Margaret A. Swallow

Authors
  1. Ravindran Pratheesh
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  2. Diane Margaret A. Swallow
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  4. K. S. Jacob
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  5. Geeta Chacko
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  7. Ari G. Chacko
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Correspondence to Ari G. Chacko.

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Pratheesh, R., Swallow, D.M.A., Rajaratnam, S. et al. Incidence, predictors and early post-operative course of diabetes insipidus in paediatric craniopharygioma: a comparison with adults. Childs Nerv Syst 29, 941–949 (2013). https://doi.org/10.1007/s00381-013-2041-8

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  • DOI: https://doi.org/10.1007/s00381-013-2041-8

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