| BackgroundCraniopharyngioma(CP)are histological benign tumors(WHO grade I)derived from embryonic squamous epithelium of Rathke's pouch remnants,may arise in any region from the sella to the third ventricle floor region.It account for approximately 2-5%of all primary intracranial tumors,can still be challenging.For many years,surgery resection of the tumor was generally believed to the optimal therapeutic option for primary CP because of its benign appearance.However,resection especially the total removal of the neoplasms can be inevitably associated with neuroendocrine sequelae due to the anatomical proximity of the tumor to the vital structures such as pituitary stalk,hypothalamus,infundibulum and tuber cinereum.Serum sodium abnormality is one of the most common manifestion among them with an incidence more than 80%following surgery of the CP.Disorder of sodium balance,especially the severe blood sodium disturbance,is a poor prognostic indicator,which closely correlates with prolonged hospital stay,poor prognosis and increased mortality,moreover,which was consider as the thorny problem faced neurosurgeons.Therefore,it is of great clinical significance to researth the characteristics and regularity of development of postoperative serum sodium in patients with CP.On the basis of the tumor origin and on the presence of an arachnoid envelope around the pituitary stalk,we established a QST typing system for CP.Although it is generally know that the serum sodium imbalance may occur in a majority of patient whom underwent gross total resection of CP,there are rare comprehensive research exploring its occurrence regularity and predictor and especially,the distinction among QST classification.Therefore,studying the characteristics and regularity of the occurrence and development of sodium disorder after craniopharyngioma and its related influencing factors can better predict its occurrence and implement individualized treatment,which is of great significance for improving the prognosis of patients.Purpose:In this study we aimed to explore regularity and possible predictor of disturbance of serum sodium and determining whether there were distinguishment in manifestation of sodium destabilization according to the QST classification based on the origin of the tumor and the concept of membrane.It may be helpful in the perioperative treatment of craniopharyngioma(CP).Methods:Retrospective analysis of clinical,biochemical,radiological and operative data for 134 successive patients undergone a primary CP removal in Department of Neurosurgery of Nanfang Hospital of Southern Medical University between September 2017 to March 2018 was done.Statistical methods were used to analyze the factors and evaluate the differences in sodium abnormalities after surgery of craniopharyngiomas among QST classification.Result:There were significant differences in age,pathological type,tumor texture,incidence of hydrocephalus,hypopituitarism and postoperative diabetes imsipidus(DI)in different types of craniopharyngioma(P<0.05).There are 60(44.8%)patients occured hyponatremia and 67(50%)patients occured hypernatremia of 134 patients,the median time of onset of hyponatremia was the 6th days after surgery,the median time of onset of hypernatremia was the first day after surgery.The incidence,timing,severity and type of sodium disturbance of different types of craniopharyngioma were significantly different by statistical tests.Moreover,age,tumor size category,calcified severity,the presence or absence of preoperative hypothalamic dysfunction(HD),DI and hydrocephalus significantly differed among the 4 subgroup classified by the type of obvious disorder of serum sodium.In type T tumors,the disorder of serum sodium of patients with adamantinomatous craniopharyngioma(ACP)and the third ventricular was defective postoperatively are more common and severe.Type of growth pattern and calcified severity as well as preoperative DI were independent prognostic factors for obvious disorder of serum sodium.The giant tumor is not a risk factor for serum sodium disturbance after surgery of craniopharyngioma.Conclusion:Hypo/hypernatremia developed in just over half of patients after primary excision of CP,but it is predictable and controllable.Total tumor resection does not increase the incidence of postoperative serum sodium disturbance.Disorders of serum sodium that occurs in early stage are more serious and it is easy to be ignored in the late stage.So we recommend that serum sodium,natriuresis and urine volume should be routinely monitored after surgery for at least 2 weeks.Grasping the QST classification is in favour of comparing and predicting the regularity of sodium imbalance as it illuminated the origin and growth pattern of CP and the different ways of tumor involvement in pituitary,stalk,and hypothalamus.Should be keep a close watch on postoperative fluctuation of serum sodium and onset of severe sodium disorders for patients with type T tumors(especially ACP and those the bottom of the third ventricle was defective),preoperative DI and severe calcification. |
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