Abstract
Purpose This article aims to identify patient- and surgery-related factors that could predict
the development of postoperative central diabetes insipidus (DI).
Methods This is a retrospective case–control study conducted at a single-institution tertiary
referral center. Patients undergoing endoscopic endonasal skull base surgery for pituitary
adenoma between November 2018 and April 2023 were recruited. The main outcome measures
collected include age, gender, comorbidities, tumor type, postoperative DI, intraoperative
and postoperative cerebrospinal fluid (CSF) leak, flow of CSF leak, number of layers
required for repair, the use of nasal packing, and hospital length of stay.
Results A total of 20 patients developed DI postoperatively. Patients' demographic and comorbidity
profile did not correlate with DI development. The encounter of an intraoperative
CSF leak was correlated with postop DI (chi-square (1) = 18.35, p < 0.001) with a relative risk (RR) of 2.7 (confidence interval [CI] = 1.37–5.28).
The use of nasal packs was also correlated with postop DI (chi-square (1) = 10.17,
p = 0.001) with a RR of 1.8 (CI = 1.15–2.87). Defects requiring a two or more layers
for reconstruction also correlated with postop DI compared to single layer repairs
(chi-square (1) = 12.15, p < 0.001) irrelevant of the materials used. Development of DI postop correlated with
an increased hospital length of stay (t(64) = –3.35, p = 0.001).
Conclusion The physician should be careful when evaluating patients with pituitary adenomas
in the postoperative period, particularly those with intraoperative CSF leak, nasal
packing, and those who underwent multilayer reconstruction of the surgical defect.
Keywords
diabetes insipidus - endoscopic surgery - skull base surgery - pituitary adenoma
