【Pediatric anesthesia】Anesthesia management of craniopharyngioma

Craniopharyngiomas Anesthesia Craniopharyngiomas are benign tumors histologically derived from the suprasellar origin, the incidence of which depends on localized damage or compression of nearby vital structures (especially the hypothalamus, optic chiasm, and pituitary glands).

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The usual treatment is surgical excision and decompression followed by radiation therapy
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 Epidemiology: 70% occur in children under the age of 15, accounting for 5-15% of primary intracranial tumors in children.
Clinical manifestations: Three major clinical symptoms 1.
Symptoms of increased intracranial pressure: headache, vomiting, papilledema
.

2.
Visual field impairment
.

3.
Endocrine dysfunction Symptoms of pituitary dysfunction: endocrine disorders (the most common) - growth and development disorders, short stature, easy fatigue, less movement, pale skin, low basal metabolic rate,
etc.

Hypothalamic symptoms: diabetes insipidus, central obesity, lethargy, thermoregulation disorders, mental symptoms,
etc.

Other: Adjacent symptoms: cerebrospinal fluid rhinorrhea, epilepsy, phantom smell, phantom taste,
etc.

Anesthesia concerns: These children often have abnormal endocrine glands, and preoperative thyroid and adrenal function tests are required
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Because the craniopharyngioma is closely related to the pituitary stalk and the hypothalamus, it is easily palpated or stretched during surgery, resulting in intraoperative and postoperative diabetes insipidus.
Surgery is also accompanied by depletion of sodium in brain tissue, causing massive diuresis
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The syndrome resolves spontaneously, but can persist for several weeks
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Treatment is supportive and includes saline infusion to compensate for increased urinary sodium
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Diabetes insipidus usually occurs within a few hours after surgery, and sometimes intraoperative diabetic diabetes insipidus occurs
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Rehydration alone is difficult to maintain blood volume or leads to unacceptable increases in blood glucose, and other pharmacological approaches must be used to treat diabetic diabetes insipidus
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Intraoperative blood glucose monitoring was continued, and insulin was used in individual doses to control blood glucose below 13 mmol/L as much as possible
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Body temperature monitoring, central hyperthermia caused by severe hypothalamic injury, also manifested as body temperature does not rise, below 32 ℃, the patient is in a critical state
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Electrolyte disturbance management
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Excerpt from: Contemporary Pediatric Anesthesiology Editor-in-Chief: Chen Yulian Qingquanwen / Wu Yajun Typesetting / Dingdang Maruko