Critical shift phase in deep vein thrombosis development after major sellar region tumor surgeries: a systematic...

Sellar region tumors, such as craniopharyngiomas, pituitary adenomas, and chordomas, pose substantial surgical complexity. Although outcomes have improved, venous thromboembolism (VTE), particularly deep vein thrombosis (DVT), remains a significant postoperative risk. While prior studies report elevated VTE incidence in neurosurgery, the specific mechanisms and timing of peak vulnerability after sellar tumor surgery are not well established.

This study aims to identify the critical shift phase of heightened DVT risk after major sellar region tumor resections and to elucidate the pathophysiologic role of perioperative neuroendocrine disturbances in inducing a hypercoagulable state.

A systematic review was performed according to PRISMA guidelines, assessing studies from PubMed, Cochrane Library, and ScienceDirect (October 2024-February 2025). Eligible studies evaluated neuroendocrine changes and DVT outcomes after sellar tumor surgery. Screening involved two independent reviewers with adjudication by a third. The review was registered in PROSPERO (CRD42024616487).

Three studies met inclusion criteria. Evidence consistently indicates that the first 10 postoperative days represent the peak DVT-risk interval, corresponding to the neuroendocrine transition from central diabetes insipidus (CDI) to syndrome of inappropriate antidiuretic hormone secretion (SIADH). This shift produces abrupt sodium fluctuations, endothelial irritation, and fluid imbalance, collectively fostering a transient but pronounced hypercoagulable state.

Sellar region tumor resection precipitates a critical shift phase in the first 10 days postoperatively, during which neuroendocrine-fluid imbalances drive hypercoagulability. Early, individualized thromboprophylaxis, tailored to serum sodium and fluid status from post operative state, may mitigate this risk.