Clinical Analysis Of Hypernatremia After Operation Of Space-occupying Lesions In The Saddle Area

Hypernatremia is one of the post-operative complications in patients withspace-occupying lesions in the saddle area, and its mortality is high. Moreover,severe hypernatremia is an independent risk factor with extremely high oddsratio for death. Plasma sodium has become an important prognostic indicator ofpost-operative patients with space-occupying lesions in the saddle area,combating the treatment about hypernatremia which happens to post-operativepatients is very difficult. This paper reviewed the pathogenesis, body impact,treatment and outcome of hypernatremia which complicate post-operativepatients with space-occupying lesions in the saddle area.Objective:Hypernatremia is a frequent complication after resection space-occupyinglesions in the saddle area. Retrospective analysis was performed among lesionstype, diameter of lesions, encroach position, operative approach, treatmenteffect, clinical mortality and outcome of hypernatremia in this article.Methods:To retrospectively study72patients with space-occupying lesions in thesaddle area in our department of neurosurgery between February2011and June2012. Of72patients,2patients were under18years old,62patients werebetween18-60years old, and8patients were over60years old. Including28 male cases,44female cases.64patients suffered from pituitary adenoma,5patients suffered from craniopharyngioma, and3patients suffered from Rathkecleft cyst. All patients were confirmed by pathology. All patients was checkedout electrolyte and kidney function on the day of operation and at7~14dayafter operation. If sodium was abnormal, it was rechecked at any timeaccording to the patient’s condition. Meanwhile we monitored heart rate, bloodpressure and urine volume in24hours of all patients, CT were performed whennecessary. Then we made a statistic analysis of the morbidity with chi squaretest (χ~2). That the value of P is less than0.05make sense in statistics (P<0.05).Results:18(25.00%,18/72) patients suffered from hypernatremia. Thehypernatremia was happened at（2.6±0.5）days after operation. The meanhospitalization time was30days. In72cases4patients’ serum sodiumconcentrations were more than160.0mmol/L,3patients were died, Themortality was4.2%. The incidence rate of postoperative hypernatremia werehigher in the patients whose lesions were located in the third ventricle oroffended the anterior ventral of the third ventricle (P<0.05). The incidence rateof postoperative hypernatremia were higher in the patients whose lesionsdiameters more than4cm (P<0.05). The incidence rate of postoperativehypernatremia were much more higher in the patients whose lesions wasresected by transcranial approach, but it was no statistical differences betweentranscranial approach and transsphenoidal approach (P>0.05). The patients whose plasma sodium concentrations were more than180.0mmol/L had3died.The mortality was75.0%(3/4) and there are obvious statistical significance(P<0.05).Conclusions:1. Hypernatremia is one of the post-operative complications in patients withspace-occupying lesions in the saddle area, lesions diameters beyond4cm andlesions in the region of the anteroventral portion of the third ventral and areclosely related to post operative hypernatremia.2. It was no statisticaldifference between transcranial approach and transsphenoidal approach inhypernatremia after post-operative patients with space-occupying lesions.3.Rehydration therapy to treat hypernatremia is effective, patients with plasmasodium concentration beyond160.0mmol/L have a high mortality, and severehypernatremia indicates poor prognosis.