Analysis Of Factors The Spontaneous Resolution Of Central Diabetes Insipidus After Transnasal Endoscopic Craniopharyngioma Surgery

Objective: Central diabetes insipidus(CDI)is the most common complication of endoscopic endonasal surgery for craniopharyngioma.However,some cases of CDI could spontaneously resolve during the follow-up period and the factors of spontaneous resolution of CDI have not been studied.Hence,this study aimed to determine the factors for the spontaneous resolution of CDI.Methods: Data of patients with CDI who underwent endoscopic endonasal surgery for craniopharyngioma between June 2012 and December 2022 were retrospectively reviewed.All patients were divided into two groups based on the resolution of CDI during follow-up(Median=17months): the recovery and no recovery groups.The baseline characteristic,surgical,and follow-up results of patients were compared.Results: We identified 101 patients with CDI(42 in the recovery group and 59 in the no recovery group).A direct comparison showed that retaining the pituitary stalk(57.1% the recovery group vs.15.3% no recovery group,P < 0.001)and nohypothalamic injury(HI)(73.8% the recovery group vs.20.3% no recovery group,P< 0.001)were more common in the recovery group,whereas hydrocephalus at diagnosis(9.5% the recovery group vs 47.5% no recovery group,P <0.001)was significantly more common in the no recovery group.Subsequently,we found through univariate and multivariate analysis that the spontaneous resolution of CDI was associated with hydrocephalus at diagnosis(yes vs.no: odds ratio [OR],0.168;P=0.009),pituitary stalk injury(retaining vs.sectioning: OR,3.677;P =0.028),and the Hong et al.HI pattern(mild-HI vs.no-HI: OR 0.200,P =0.033;unilateral-HI vs.noHI: OR 0.232,P =0.040;bilateral-HI vs.no-HI: OR 0.080,P =0.004).Conclusions: Hydrocephalus at diagnosis,pituitary stalk injury,and the Hong et al.HI pattern might be factors of the spontaneous resolution of CDI following endoscopic endonasal surgery for craniopharyngioma.