Postoperative intensive care management and residual endocrinopathy of pediatric supratentorial brain tumors: a retrospective cohort study
- 20 April 2022
- journal article
- research article
- Published by Walter de Gruyter GmbH in Journal of Pediatric Endocrinology and Metabolism
- Vol. 35 (6), 795-802
- https://doi.org/10.1515/jpem-2021-0779
Abstract
Objectives Endocrinopathy can occur as a postoperative sequel in children treated for supratentorial tumors (STTs). We assessed prediction of a residual hypothalamic/pituitary insufficiency (HPI) in these patients and factors associated with prolonged length of hospital stay (LOS). Methods This is a retrospective cohort study of children who had surgery for STTs in two tertiary centers in Saudi Arabia (2009–2019). We assessed PICU postoperative management and risk of HPI. Data were analyzed using SPSS V24.0 and a logistic regression model for a prediction of a prolonged LOS. Results Data included 55 children (1–18 years, mean 9.5 ± 4.9 years) who required STT surgeries, 32 (54%) females. Craniopharyngioma (27.3%) was the commonest STTs and 20% of patients had initial symptoms of HPI. PICU management included the use of different types of intravenous fluids (IVFs) and medications such as steroids and desmopressin (DDAVP). An early postoperative DI was reported in 21.8% (n=12/55). Residual HPI included 24 (43.6%) presumed cortisol deficient and 18 (32.7%) central DI patients. Risk factors for postoperative HPI were female gender, age <6 years, headache and preoperative pituitary symptoms. LOS (Median=25.5 ± 12.2 days) was significantly prolonged in patients who required two or more doses of DDAVP [B=13; 95% CI= (1.7–24.3) days] and reduced in patients who had suspected preoperative HPI [B=−19.6; 95% CI= (−31.1, −8.2) days]. Conclusions Prediction of postoperative HPI in pediatric STTs enhances an early initiation of treatment in PICU and reduces LOS. A meticulous use of IVF and medications supervised by a multidisciplinary team is essential for a favorable outcome.Keywords
This publication has 24 references indexed in Scilit:
- Etiology of postoperative hyponatremia following pediatric intracranial tumor surgeryJournal of Neurosurgery: Pediatrics, 2016
- Quality of survival assessment in European childhood brain tumour trials, for children aged 5 years and overEuropean Journal of Paediatric Neurology, 2015
- Cerebrospinal Fluid Leak Risk Factors in Pediatric Patients undergoing Endoscopic Endonasal Skull Base SurgeryJournal of Neurological Surgery Part B: Skull Base, 2015
- The Costs of Skull Base Surgery in the Pediatric PopulationJournal of Neurological Surgery Part B: Skull Base, 2014
- Hypernatremia Is Associated with Increased Risk of Mortality in Pediatric Severe Traumatic Brain InjuryJournal of Neurotrauma, 2013
- Treatment-related morbidity and the management of pediatric craniopharyngiomaJournal of Neurosurgery: Pediatrics, 2012
- Frequent Occurrence of the Triphasic Response (Diabetes Insipidus/Hyponatremia/Diabetes Insipidus) after Surgery for Craniopharyngioma in ChildhoodHormone Research in Paediatrics, 2011
- Quality of postoperative course in children: endoscopic endonasal surgery versus sublabial microsurgeryActa Neurochirurgica, 2011
- Presentation of childhood CNS tumours: a systematic review and meta-analysisThe Lancet Oncology, 2007
- Endocrine and cardiovascular late effects among adult survivors of childhood brain tumorsCancer, 2003