Delayed Postoperative Hyponatremia Following Endoscopic Transsphenoidal Surgery for Non-Adenomatous Parasellar Tumors

SIMPLE SUMMARY: Delayed postoperative hyponatremia is a known complication after transsphenoidal surgery for pituitary adenoma, but this may occur after surgery for parasellar non-adenomatous skull base tumors (NASBTs). Due to their scarcity, however, little is known about this condition. Through a retrospective review of 30 patients with NASBTs and detailed analyses on perioperative serial sodium level, we found that serological hyponatremia (sodium ≤ 135 mmol/L) occurred in eight (27%) on postoperative day 7–12, with four (13%) of them being symptomatic. Four (50%) showed weight loss and hemoconcentration suggesting cerebral salt wasting type, and three (38%) showed weight gain and hemodilution, suggesting a syndrome of inappropriate antidiuretic hormone secretion. Hyponatremia should be recognized as a possible complication after transsphenoidal resection of NASBTs. Intraoperative extradural retraction of the pituitary gland was the only significant factor for serological hyponatremia, suggesting the maneuver and subsequent dysregulation of the hypothalamo-hypophyseal axis may be responsible. ABSTRACT: Little is known about delayed postoperative hyponatremia (DPH) accompanied with transsphenoidal surgery for non-adenomatous skull base tumors (NASBTs). Consecutive data on 30 patients with parasellar NASBT was retrospectively reviewed with detailed analyses on perioperative serial sodium levels. Serological DPH (sodium ≤ 135 mmol/L) was observed in eight (27%), with four (13%) of them being symptomatic. DPH developed on postoperative day 7–12 where the mean sodium levels were 134 mmol/L (a mean of 7 mmol/L drop from the baseline) in asymptomatic and 125 mmol/L (a mean of 17.5 mmol/L drop from the baseline) in symptomatic DPH. Serological DPH was accompanied with “weight loss and hemoconcentration (cerebral salt wasting type)” in four (50%), “weight gain and hemodilution (syndrome of inappropriate antidiuretic hormone secretion type)” in three (38%), and no significant weight change in one. Intraoperative extradural retraction of the pituitary gland was the only significant factor for serological DPH (p = 0.035; odds ratio, 12.25 (95% confidence interval, 1.27–118.36)). DPH should be recognized as one of the significant postsurgical complications associated with TSS for NASBTs. Although the underlying mechanism is still controversial, intraoperative extradural compression of the pituitary gland and subsequent dysregulation of the hypothalamo-hypophyseal axis may be responsible.