TY - JOUR
T1 - The effect of centralized care on the management of postoperative fluctuations in plasma sodium concentration after pediatric suprasellar brain tumor surgery
AU - Hulsmann, S. C.
AU - Zaal, D. C.
AU - van Gestel, J. P.J.
AU - Sie, M.
AU - Rooda, O. H.J.Eelkman
AU - van Baarsen, K. M.
AU - Musson, R. E.A.
AU - Bakker, B.
AU - Nieuwenhuis, E. E.S.
AU - Hoving, E. W.
AU - Asperen, R. M.Wösten van
AU - van Santen, H. M.
N1 - Publisher Copyright:
© The Author(s) 2026.
PY - 2026/3/29
Y1 - 2026/3/29
N2 - PURPOSE: Children undergoing neurosurgery for (supra)sellar tumors are at risk of developing arginine vasopressin-deficiency (AVP-D), which can cause severe sodium fluctuations and associated neurological complications, prolonged hospitalization and mortality. A previous Dutch study reported sodium shifts ≥ 10 mmol/L/24 h in 75.3% of patients with early postoperative AVP-D, with a maximum delta of 46 mmol/L/24 h. Since 2018, pediatric oncology care has been centralized in the Netherlands. We evaluated the impact of this centralization on postoperative sodium fluctuations in children with (supra)sellar tumors.METHODS: Data from all children who underwent neurosurgery for a (supra)sellar tumor at the Princess Máxima Centrum (Utrecht, the Netherlands) between January 2018 and December 2023 were retrospectively collected from electronic health records, including presence of preoperative AVP-D, plasma sodium concentrations during the first 10 postoperative days, administration of desmopressin, and short- and long-term neurological symptoms. Results were additionally interpreted in the context of pre-centralization data.RESULTS: Among 73 patients with a median age of 7.9 years (range 0-17.5) at tumor resection, postoperative AVP-D occurred in 69.7%. During the first 10 postoperative days, sodium fluctuations ≥ 10 mmol/L/24 h were seen in 49.1% of these patients, with a maximum delta of 30 mmol/L/24 h. Since 2018, sodium fluctuations diminished, with a maximum delta plasma sodium of 14 mmol/L/24 h in 2023. No association was found between early postoperative AVP-D and occurrence of neurological symptoms.CONCLUSION: Trends observed after centralization of care for children with (supra)sellar tumors may suggest improved postoperative AVP-D management, resulting in less frequent and less severe fluctuations in plasma sodium concentrations.SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11102-026-01666-w.
AB - PURPOSE: Children undergoing neurosurgery for (supra)sellar tumors are at risk of developing arginine vasopressin-deficiency (AVP-D), which can cause severe sodium fluctuations and associated neurological complications, prolonged hospitalization and mortality. A previous Dutch study reported sodium shifts ≥ 10 mmol/L/24 h in 75.3% of patients with early postoperative AVP-D, with a maximum delta of 46 mmol/L/24 h. Since 2018, pediatric oncology care has been centralized in the Netherlands. We evaluated the impact of this centralization on postoperative sodium fluctuations in children with (supra)sellar tumors.METHODS: Data from all children who underwent neurosurgery for a (supra)sellar tumor at the Princess Máxima Centrum (Utrecht, the Netherlands) between January 2018 and December 2023 were retrospectively collected from electronic health records, including presence of preoperative AVP-D, plasma sodium concentrations during the first 10 postoperative days, administration of desmopressin, and short- and long-term neurological symptoms. Results were additionally interpreted in the context of pre-centralization data.RESULTS: Among 73 patients with a median age of 7.9 years (range 0-17.5) at tumor resection, postoperative AVP-D occurred in 69.7%. During the first 10 postoperative days, sodium fluctuations ≥ 10 mmol/L/24 h were seen in 49.1% of these patients, with a maximum delta of 30 mmol/L/24 h. Since 2018, sodium fluctuations diminished, with a maximum delta plasma sodium of 14 mmol/L/24 h in 2023. No association was found between early postoperative AVP-D and occurrence of neurological symptoms.CONCLUSION: Trends observed after centralization of care for children with (supra)sellar tumors may suggest improved postoperative AVP-D management, resulting in less frequent and less severe fluctuations in plasma sodium concentrations.SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11102-026-01666-w.
KW - Arginine vasopressin deficiency
KW - Centralized care
KW - Diabetes insipidus
KW - Pediatric
KW - Plasma sodium concentration
KW - Suprasellar tumor
UR - https://www.scopus.com/pages/publications/105034704960
UR - https://www.mendeley.com/catalogue/7e47cf9a-2aa4-3731-9258-5178ca024efa/
U2 - 10.1007/s11102-026-01666-w
DO - 10.1007/s11102-026-01666-w
M3 - Article
C2 - 41904736
AN - SCOPUS:105034704960
SN - 1386-341X
VL - 29
JO - Pituitary
JF - Pituitary
IS - 2
M1 - 65
ER -