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The Difference Between Preoperative and Postoperative Pituitary Stalk Deviation Angles Can Predict Delayed
Kunzhe Lin1, Ran Zeng2, Zhijie Pei3
1Department of Neurosurgery, Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, Fujian, China.
World Neurosurgery
|September 4, 2021
Summary
Delayed hyponatremia after transsphenoidal surgery (TSS) for pituitary adenomas is linked to significant changes in pituitary stalk deviation. A larger difference in deviation angles increases the risk of this complication.
Area of Science:
- Neurosurgery
- Endocrinology
- Radiology
Background:
- Transsphenoidal surgery (TSS) is a common treatment for pituitary adenomas.
- Delayed hyponatremia is a potential postoperative complication following TSS.
- Predicting and preventing delayed hyponatremia is crucial for patient outcomes.
Purpose of the Study:
- To identify factors influencing delayed hyponatremia after TSS for pituitary adenomas.
- To analyze the impact of pituitary stalk deviation angle changes on delayed hyponatremia.
- To establish predictors for postoperative delayed hyponatremia.
Main Methods:
- Retrospective study of clinical data from 422 patients undergoing microscopic TSS.
- Assessment of pituitary stalk deviation angles and "measurable pituitary stalk" length using MRI.
- Univariate and multivariate logistic regression analyses to determine predictors.
Main Results:
- 66 out of 422 patients developed delayed hyponatremia.
- Increased difference in preoperative and postoperative pituitary stalk deviation angles significantly predicted delayed hyponatremia (OR=1.040, P<0.001).
- A larger difference in "measurable pituitary stalk" length also correlated with higher risk (OR=1.128, P=0.032).
- Higher postoperative day 2 blood sodium levels were associated with a lower risk.
Conclusions:
- The difference between preoperative and postoperative pituitary stalk deviation angles is a significant predictor of delayed hyponatremia post-TSS.
- Changes in pituitary stalk morphology, including deviation and measurable length, are critical factors.
- These findings offer valuable insights for risk stratification and management of patients undergoing TSS.
