Suction decompression during clipping of either large or giant internal carotid artery (ICA) aneurysms is useful and associated with good outcomes. However, it is also associated with increased risk of ICA dissection and cerebral embolism. Given that the risk of hyponatremia is yet to be fully described, we here present cases of hyponatremia following direct clipping of ICA aneurysms with suction decompression. In addition, its etiology will also be discussed.
Of 5 consecutive patients, who underwent clipping of ICA aneurysms with suction decompression between July 2016 and August 2017, 3 developed delayed symptomatic hyponatremia.
Specifically, the patients’ characteristics were the following: 2 females and 1 male, average age of 52.7 years (range: 41-60 years). While 2 patients presented aneurysms in their paraclinoid ICA, the aneurysm was found in the posterior communicating artery bifurcation of the remaining subject. Hyponatremia occurred on average at 7 days after surgery (range from 4 to 10 days) and all patients were treated with salt and fluid replacement, which improved their symptoms.
Hyponatremia is a common complication resulting from pituitary tumor surgery, with the main cause being the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). However, we propose that the hyponatremia observed in our cases might have developed due to SIADH caused by ischemia of the pituitary stalk.
To conclude, cases of hyponatremia following the direct clipping of ICA aneurysms with suction decompression were reported. Therefore, the occurrence of delayed hyponatremia as a complication of clipping with suction decompression should be properly addressed and managed.