Hasegawa Hirotaka, Shin Masahiro, Makita Noriko, Shinya Yuki, Kondo Kenji, Saito Nobuhito
Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan.
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Cancers (Basel). 2020 Dec 20;12(12):3849. doi: 10.3390/cancers12123849.
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 ( = 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.
关于非腺瘤性颅底肿瘤（NASBTs）经蝶窦手术伴发的术后迟发性低钠血症（DPH），目前所知甚少。对30例鞍旁NASBT患者的连续数据进行回顾性分析，并对围手术期系列钠水平进行详细分析。8例（27%）患者出现血清学DPH（血钠≤135 mmol/L），其中4例（13%）有症状。DPH发生在术后第7 - 12天，无症状患者的平均血钠水平为134 mmol/L（较基线平均下降7 mmol/L），有症状的DPH患者平均血钠水平为125 mmol/L（较基线平均下降17.5 mmol/L）。4例（50%）血清学DPH伴有“体重减轻和血液浓缩（脑性盐耗损型）”，3例（38%）伴有“体重增加和血液稀释（抗利尿激素分泌不当综合征型）”，1例体重无明显变化。垂体硬膜外术中牵拉是血清学DPH的唯一显著因素（P = 0.035；比值比，12.25（95%置信区间，1.27 - 118.36））。DPH应被视为NASBTs经蝶窦手术相关的重要术后并发症之一。尽管其潜在机制仍存在争议，但术中垂体硬膜外压迫及随后下丘脑 - 垂体轴的调节异常可能是原因所在。
