Perioperative Management of a Child With Pre-existing Diabetes Insipidus Undergoing Craniopharyngioma Excision: A Case Report

Craniopharyngiomas are rare tumors arising in the suprasellar area of the brain and are more common in the pediatric age group. Due to the involvement of the hypothalamus, central diabetes insipidus (DI) is usually associated with such lesions. Patients with DI are at risk for significant electrolyte disturbances due to high urine output and the potential for sodium imbalance. Perioperative management of a patient with co-existing DI is challenging due to the imbalances in the fluid and electrolyte status. We reported a rare case of successful intraoperative anesthetic management of a pediatric patient undergoing craniopharyngioma excision with pre-existing central DI. The main anesthetic concerns were intraoperative fluid and electrolyte disbalance, and further risk of hypothalamic damage with the possibility of seizure, hyperthermia, and hemodynamic instability. Intraoperatively, a meticulous fluid management strategy was employed, keeping a strict watch on urine output and serum electrolyte levels. Intraoperative DI was treated with low-dose vasopressin infusion. Intensive monitoring of the fluid and electrolyte status in a patient during craniopharyngioma surgery is of utmost importance. A proper collaborative team effort between the neurosurgeons, neuroanesthesiologists, and the neuroendocrine team is essential for a successful outcome.