소아 뇌종양 수술 후 수분대사 및 전해질 장애

Abstract

PURPOSE: One of the most challenging problems associated with brain tumor surgery is the occurrence of water and electrolyte disturbances (WEDs) due to antidiuretic hormone (ADH) imbalance. This study was performed to investigate the incidence, risk factors and natural history of WEDs occurring after brain tumor surgery. METHODS: We analyzed the clinical course and laboratory records of children who showed WEDs after brain tumor operation at Severance Children's Hospital between February 2004 and February 2009. RESULTS: Fifty-two of 53 (20.0%) patients with WEDs (total, 265 cases) were diagnosed with diabetes insipidus (DI), and 1 patient was diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Eighteen patients had preoperative DI, which developed into a permanent condition. In another group of 34 patients, 7 had transient DI, while the remaining 27 patients, including 6 children with hyponatremia, showed progression to permanent DI. Among 30 patients with craniopharyngioma, 7 developed preoperative DI; 2, transient DI; and 15, postoperative permanent DI. Among 24 patients with germinoma, 8 showed preoperative DI; 1, transient DI; and 4, postoperative permanent DI. In addition, among 17 patients with pituitary adenoma, 3 developed transient DI and 3 others developed postoperative permanent DI. The incidence of WEDs was high (50.5%) in patients with the abovementioned tumors, especially among those with suprasellar or hypothalamic lesions. CONCLUSION: Careful postoperative monitoring for WEDs is necessary for patients who have been preoperatively diagnosed with DI or suprasellar or hypothalamic lesions. Further, we recommend that postsurgical reassessment for DI should be performed in patients showing symptoms of DI