Burke William T, Cote David J, Penn David L, Iuliano Sherry, McMillen Katie, Laws Edward R
University of Louisville School of Medicine, University of Louisville, Louisville, Kentucky.
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Neurosurgery. 2020 Oct 15;87(5):949-955. doi: 10.1093/neuros/nyaa148.
Diabetes insipidus (DI) is a recognized transient or permanent complication following transsphenoidal surgery (TSS) for pituitary tumors.
To describe significant experience with the incidence of DI after TSS, identifying predictive characteristics and describing our diagnosis and management of postoperative DI.
A retrospective analysis was performed of 700 patients who underwent endoscopic TSS for resection of pituitary adenoma (PA), Rathke cleft cyst (RCC), or craniopharyngioma. Inclusion criteria included at least 1 wk of follow-up for diagnosis of postoperative DI. Permanent DI was defined as DI symptoms and/or need for desmopressin more than 1 yr postoperatively. All patients with at least 1 yr of follow-up (n = 345) were included in analyses of permanent DI. Multivariable logistic regression models were constructed to identify predictors of transient or permanent postoperative DI.
The overall rate of any postoperative DI was 14.7% (103/700). Permanent DI developed in 4.6% (16/345). The median follow-up was 10.7 mo (range: 0.2-136.6). Compared to patients with PA, patients with RCC (odds ratio [OR] = 2.2, 95% CI: 1.2-3.9; P = .009) and craniopharyngioma (OR = 7.0, 95% CI: 2.9-16.9; P ≤ .001) were more likely to develop postoperative DI. Furthermore, patients with RCC (OR = 6.1, 95% CI: 1.8-20.6; P = .004) or craniopharyngioma (OR = 18.8, 95% CI: 4.9-72.6; P ≤ .001) were more likely to develop permanent DI compared to those with PA.
Although transient DI is a relatively common complication of endoscopic and microscopic TSS, permanent DI is much less frequent. The underlying pathology is an important predictor of both occurrence and permanency of postoperative DI.
尿崩症（DI）是垂体肿瘤经蝶窦手术（TSS）后公认的一种短暂性或永久性并发症。
描述TSS术后DI发生率的重要经验，确定预测特征，并描述我们对术后DI的诊断和管理。
对700例行内镜TSS切除垂体腺瘤（PA）、拉克氏囊肿（RCC）或颅咽管瘤的患者进行回顾性分析。纳入标准包括至少1周的随访以诊断术后DI。永久性DI定义为术后1年以上出现DI症状和/或需要去氨加压素治疗。所有随访至少1年的患者（n = 345）纳入永久性DI分析。构建多变量逻辑回归模型以确定术后短暂性或永久性DI的预测因素。
术后任何类型DI的总体发生率为14.7%（103/700）。永久性DI发生率为4.6%（16/345）。中位随访时间为10.7个月（范围：0.2 - 136.6个月）。与PA患者相比，RCC患者（比值比[OR]=2.2，95%置信区间：1.2 - 3.9；P = 0.009）和颅咽管瘤患者（OR = 7.0，95%置信区间：2.9 - 16.9；P≤0.001）更易发生术后DI。此外，与PA患者相比，RCC患者（OR = 6.1，95%置信区间：1.8 - 20.6；P = 0.004）或颅咽管瘤患者（OR = 18.8，95%置信区间：4.9 - 72.6；P≤0.001）更易发生永久性DI。
虽然短暂性DI是内镜和显微镜下TSS相对常见的并发症，但永久性DI则少见得多。潜在病理是术后DI发生和永久性的重要预测因素。
