Cerebral Salt Wasting Syndrome in Post-Op Pediatric Brain Tumor Patients

CSWS should be strongly considered in hyponatremic pediatric patients following brain tumor resection.

Cerebral Salt Wasting Syndrome in Post-Operative Pediatric Brain Tumor Patients

The diagnosis of (cerebral salt wasting syndrome) CSWS should be strongly considered in hyponatremic pediatric patients with significant natriuresis following brain tumor resection, and a treatment initiated promptly to prevent neurologic sequeleae, according to a study published recently in Neurocritical Care.

“CSWS and the syndrome of inappropriate antidiuretic hormone [SIADH] are both causes of hyponatremia in pediatric neurosurgical patients, often with similar presenting symptoms; however, despite similar clinical characteristics, the treatment for CSWS and SIADH can be drastically different, which makes the distinction critical for post-operative treatment,” the authors wrote in the study abstract. The researchers were led by Douglas A. Hardestry, MD, of the Department of Neurosurgery at Children’s Hospital of Philadelphia and the University of Pennsylvania Medical Center

“Further complicating matters are the exact mechanism for CSWS, which remains unclear, and the [fact that the] incidence and severity of CSWS is not well studied in pediatric neurosurgical patients. We hypothesized that CSWS occurs frequently in post-operative brain tumor patients and is an important cause of post-operative hyponatremia in these patients.”

The authors designed a single institution retrospective cohort study of all pediatric brain tumor patients undergoing craniotomy for tumor resection at their institution between January 2005 and December 2009.

According to the study abstract, of the 282 patients undergoing 291 operations, post-operative CSWS was identified in 15 cases (5%), and was more frequently observed than SIADH (nine cases, 3%).

“Median onset of CSWS was on post-operative day three, lasting a median of 2.5 days. Patients with CSWS were more likely to have suffered post-operative stroke (40 vs. 4.6%, P < 0.001), have chiasmatic/hypothalamic tumors (40 vs. 3.8%, P = 0.002), and be younger (mean age 5.9 vs. 9.7 years, P = 0.01) than eunatremic patients. In addition, nearly half of the patients with CSWS (47%) had post-operative hyponatremic seizures,” the authors concluded in the abstract.

Cerebral Salt Wasting Syndrome in Post-Operative Pediatric Brain Tumor Patients [Neurocritical Care]