title: Pediatric anterior visual pathway gliomas: trends in fluid and electrolyte dynamics and their management nuances.
abstract: OBJECTIVE
  Trends in pre- and postoperative fluid, electrolyte and osmolarity changes, and incidence of diabetes insipidus (DI) were assessed in pediatric patients with anterior visual pathway gliomas (AVPGs).
  
  
  METHODS
  Thirty-three patients with AVPGs (age < 16 years) were divided into two groups: (1) no hypothalamic involvement [NHI; n = 17 (51.5 %) including optic (5, 15.2 %); chiasmal (5, 15.2 %); and optico-chiasmal (7, 21.2 %)] and (2) hypothalamic involvement [HI; n = 16 (48.5 %) including chiasmal-hypothalamic (12, 36.4 %) and optico-chiasmal-hypothalamic (4, 12.1 %)]. Frontotemporal transylvian decompression/biopsy was undertaken in 32 patients, while one patient (with severe diencephalic syndrome) was treated conservatively. Their endocrinal and fluid/electrolyte balance, serum osmolarity, and DI status were noted. Chi-square test compared clinical/endocrinological parameters, and unpaired T test evaluated mean daily water/electrolyte changes (p value < 0.05: significant).
  
  
  RESULTS
  Significant visual deterioration (perception of light (PL) positive (left: n = 4; right: n = 4) and PL negative (left: n = 5; right: n = 5) was encountered due to optic atrophy. Larger lesions (>3 cm), hydrocephalus [(NHI: n = 7, 41.18 %; HI: n = 12, 75 %), endocrinopathies (p = 0.047), Na(+)/K(+) derangements, and preoperative DI (n = 8, p = 0.004)] were present in the group HI. Increased postoperative urine output (almost double in those with hypothalamic involvement) and hypernatremia/hyperkalemia were seen in group HI until the sixth postoperative day (p < 0.05). Two patients with progressive hypernatremia without increased urine output showed dehydration on central venous pressure monitoring and improved with vasopressin administration. Five patients [NHI: n = 4 (23.5 %); HI: n = 1 (6.3 %)] had neurofibromatosis types I and 3 (NHI: n = 1, 5.9 %; HI: n = 2, 12.5 %) had a diencephalic syndrome.
  
  
  CONCLUSIONS
  Hypothalamic infiltration significantly increases the incidence of DI and fluid and electrolyte disturbances. Strict vigilance over postoperative fluid balance is mandatory during the first postoperative week. Rapidly rising serial serum sodium values without increased urine output mandates immediate central venous pressure measurement to detect DI associated with dehydration.
authors.affiliation: Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
authors.forename: Devesh K
authors.initials: DK
authors.lastname: Singh
authors.forename: Sanjay
authors.initials: S
authors.lastname: Behari
authors.forename: Awadhesh K
authors.initials: AK
authors.lastname: Jaiswal
authors.forename: Rabi N
authors.initials: RN
authors.lastname: Sahu
authors.forename: Arun K
authors.initials: AK
authors.lastname: Srivastava
authors.forename: Anant
authors.initials: A
authors.lastname: Mehrotra
authors.forename: Preeti
authors.initials: P
authors.lastname: Dabadgaon
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D004573:Electrolytes / Q000378:metabolism*; D005260:Female; D005910:Glioma / Q000150:complications / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009897:Optic Chiasm / Q000473:pathology; D020339:Optic Nerve Glioma / Q000150:complications / Q000628:therapy*; D010372:Pediatrics; D013997:Time Factors; D014795:Visual Pathways / Q000473:pathology*; D014883:Water-Electrolyte Imbalance / Q000209:etiology
chemical_list: D004573:Electrolytes