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Vascular complications in craniopharyngioma-resected paediatric patients: a single-center experience
Barbara Castelli1,2, Mirko Scagnet3, Federico Mussa3
1Department of Health Sciences, University of Florence, Florence, Italy.
Insights
Pediatric craniopharyngioma patients undergoing neurosurgery face risks of deep venous thrombosis and vascular issues, particularly during specific hormonal shifts. Close monitoring for these vascular complications is essential post-surgery.
Area of Science:
- Neurosurgery
- Pediatric Endocrinology
- Vascular Medicine
Background:
- Craniopharyngioma (CP) is a benign brain tumor associated with significant morbidity, primarily due to endocrine dysfunction and electrolyte imbalances.
- Vascular complications, including deep venous thrombosis (DVT), are an underreported concern in pediatric CP patients undergoing neurosurgery.
- Limited data exists on the incidence and risk factors for vascular events in this specific population.
Purpose of the Study:
- To investigate the occurrence, timing, and predisposing factors of DVT and other vascular alterations in pediatric patients with craniopharyngioma following neurosurgery.
- To identify specific clinical or laboratory markers associated with increased risk of vascular events.
Main Methods:
- A retrospective single-center study was conducted on 19 pediatric craniopharyngioma patients who underwent neurosurgery.
- Data collected included patient demographics, surgical details, post-operative complications, and laboratory values.
- Vascular events, including DVT and arterial pseudoaneurysm, were documented and analyzed in relation to clinical factors and electrolyte balance.
Main Results:
- Vascular events occurred in 26.3% of patients, predominantly linked to sodium imbalances.
- Three cases of DVT (two with pulmonary embolism) were observed post-operatively, typically 7-10 days after surgery.
- Elevated D-dimers, reduced partial activated thrombin time, and prolonged C-reactive protein increases correlated with thrombotic events. One posterior cerebral artery pseudoaneurysm and one superficial vein thrombophlebitis were also noted.
Conclusions:
- Pediatric craniopharyngioma patients undergoing neurosurgery are at risk for DVT and other vascular complications.
- The transition period between central diabetes insipidus and syndrome of inappropriate antidiuretic hormone secretion appears to be a high-risk phase for DVT.
- Mandatory and careful vascular follow-up is crucial for these patients.
Background:
Craniopharyngioma (CP), although slow growing and histologically benign, has high morbidity, mostly related to hypothalamus-pituitary dysfunction and electrolyte imbalance. Increased risk of vascular complications has been described. However, data are still poor, especially in the paediatric population. The aim of our study was to evaluate the occurrence, timing, and predisposing factors of deep venous thrombosis (DVT) and other vascular alterations in neurosurgical paediatric CP patients.
Materials And Methods:
In a single-centre, retrospective study, we investigated 19 CP patients (11 males, 8 females, mean age 10.5 ± 4.3 years), who underwent neurosurgery between December 2016 and August 2022, referred to Meyer Children's Hospital IRCCS in Florence.
Results:
Five patients (26.3%) presented vascular events, which all occurred in connection with sodium imbalances. Three DVT (two with associated pulmonary embolism, in one case leading to death) developed in the post-operative period, most frequently at 7-10 days. Elevated D-dimers, a reduced partial activated thrombin time and a prolonged C-reactive protein increase were highly related to thrombotic vascular events. One case of posterior cerebral artery pseudoaneurysm was described soon after neurosurgery, requiring vascular stenting. Superficial vein thrombophlebitis was a late complication in one patient with other predisposing factors.
Conclusion:
CP patients undergoing neurosurgery are at risk of developing DVT and vascular alterations, thus careful follow-up is mandatory. In our study, we found that the phase of transition from central diabetes insipidus to a syndrome of inappropriate antidiuretic hormone secretion may be a period of significant risk for DVT occurrence. Careful vascular follow-up is mandatory in CP-operated patients.
