Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Department of Neurosurgery and Neuro-Endovascular Therapy, Hiroshima Prefectural Hospital, Hiroshima, 7348530, Japan.
Pituitary. 2022 Feb;25(1):100-107. doi: 10.1007/s11102-021-01175-y. Epub 2021 Jul 20.
Diabetes insipidus (DI) following transsphenoidal surgery (TSS) is a common complication. Although postoperative DI often occurs in patients with craniopharyngioma and Rathke's cleft cyst, postoperative DI in patients with non-functioning pituitary adenoma (NFPA) has not been fully examined. We clarified the clinical characteristics and magnetic resonance imaging (MRI) findings predicting postoperative DI in NFPAs.
A total of 333 patients undergoing initial TSS for NFPA were included in this retrospective study. Hyperintensity (HI) in the posterior pituitary lobe was evaluated on preoperative T1-weighted MRI. Based on the findings of HI patients were divided into three groups as follows: HI was not detected (Disappearance group), HI located intrasellarly (Intrasellar group), and HI located suprasellarly (Suprasellar group).
The overall rate of DI was 21.9%, including permanent DI in 0.6%. DI occurred at postoperative day 1 (72.6%) or day 2 (19.2%) and improved within 7 days in most cases (87.7%). Univariable and multivariable analyses showed that the predictive factors of DI were a younger age (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.95-0.99, P = 0.0037) and larger tumor diameter (OR 1.04, 95% CI 1.01-1.08, P = 0.0155). The rate of DI was highest in the Disappearance group (43.8%) followed by the Intrasellar group (26.0%). The OR was 2.17 in the Intrasellar group compared with the Suprasellar group (95% CI 1.17-4.02, P = 0.0141).
Factors predicting DI following TSS for NFPA were a younger age, larger tumor size, and the location of intrasellar HI on preoperative T1-weighted MRI.
经蝶窦手术（TSS）后发生尿崩症（DI）是一种常见的并发症。虽然颅咽管瘤和 Rathke 裂囊肿患者术后常发生 DI，但无功能垂体腺瘤（NFPA）患者术后 DI 尚未得到充分研究。我们阐明了预测 NFPA 患者术后 DI 的临床特征和磁共振成像（MRI）表现。
本回顾性研究纳入了 333 例接受初次 TSS 治疗的 NFPA 患者。评估术前 T1 加权 MRI 中后垂体叶的高信号（HI）。根据 HI 患者的发现将他们分为三组：未检测到 HI（消失组）、HI 位于鞍内（鞍内组）和 HI 位于鞍上（鞍上组）。
总体 DI 发生率为 21.9%，包括永久性 DI 为 0.6%。DI 发生在术后第 1 天（72.6%）或第 2 天（19.2%），大多数情况下在 7 天内得到改善（87.7%）。单变量和多变量分析显示，DI 的预测因素为年龄较小（优势比 [OR] 0.97，95%置信区间 [CI] 0.95-0.99，P = 0.0037）和肿瘤直径较大（OR 1.04，95%CI 1.01-1.08，P = 0.0155）。消失组的 DI 发生率最高（43.8%），其次是鞍内组（26.0%）。与鞍上组相比，鞍内组的 OR 为 2.17（95%CI 1.17-4.02，P = 0.0141）。
预测 NFPA 患者 TSS 后发生 DI 的因素是年龄较小、肿瘤较大、术前 T1 加权 MRI 上鞍内 HI 的位置。
