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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2024; 85(02): e83-e87
DOI: 10.1055/a-2324-1303
Original Report

Diabetes Insipidus after Endoscopic Endonasal Pituitary Macroadenoma Resection: Correlation of Patient and Surgery-Related Risk Factors

Jad Hosri 
1   Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
,
Christophe Abi Zeid Daou
1   Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
,
Hussein Darwish   *
2   Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon
,
Zeina Korban   *
1   Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Abstract

Purpose This article aims to identify patient- and surgery-related factors that could predict the development of postoperative central diabetes insipidus (DI).

Methods This is a retrospective case–control study conducted at a single-institution tertiary referral center. Patients undergoing endoscopic endonasal skull base surgery for pituitary adenoma between November 2018 and April 2023 were recruited. The main outcome measures collected include age, gender, comorbidities, tumor type, postoperative DI, intraoperative and postoperative cerebrospinal fluid (CSF) leak, flow of CSF leak, number of layers required for repair, the use of nasal packing, and hospital length of stay.

Results A total of 20 patients developed DI postoperatively. Patients' demographic and comorbidity profile did not correlate with DI development. The encounter of an intraoperative CSF leak was correlated with postop DI (chi-square (1) = 18.35, p < 0.001) with a relative risk (RR) of 2.7 (confidence interval [CI] = 1.37–5.28). The use of nasal packs was also correlated with postop DI (chi-square (1) = 10.17, p = 0.001) with a RR of 1.8 (CI = 1.15–2.87). Defects requiring a two or more layers for reconstruction also correlated with postop DI compared to single layer repairs (chi-square (1) = 12.15, p < 0.001) irrelevant of the materials used. Development of DI postop correlated with an increased hospital length of stay (t(64) = –3.35, p = 0.001).

Conclusion The physician should be careful when evaluating patients with pituitary adenomas in the postoperative period, particularly those with intraoperative CSF leak, nasal packing, and those who underwent multilayer reconstruction of the surgical defect.

Keywords

diabetes insipidus - endoscopic surgery - skull base surgery - pituitary adenoma

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.


Informed Consent

Due to the retrospective nature of the study, the rights to obtain informed consent were waived.


* Both senior authors contributed equally to this article.




Publication History

Received: 09 April 2024

Accepted: 10 May 2024

Accepted Manuscript online:
15 May 2024

Article published online:
04 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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