Central Diabetes Insipidus After Epilepsy Surgery: Lessons from Two Unusual Cases

Background: Postoperative central diabetes insipidus (DI) is a recognized complication of neurosurgical procedures involving the hypothalamic–pituitary axis (HPA). However, its occurrence following epilepsy surgery and nonpituitary cranial procedures is uncommon and may be underrecognized. Objective: To describe two cases of postoperative central DI following distinct neurosurgical interventions and highlight diagnostic and management considerations. Methods: Retrospective descriptive analysis of two patients who developed polyuria and electrolyte imbalance following neurosurgical procedures at a tertiary care center. Clinical features, biochemical parameters, imaging, and outcomes were reviewed. Case 1: 26 years/Male Diagnosis: Nonlesional Lennox–Gastaut syndrome Procedure: Corpus callosotomy Postoperative course: Developed polyuria (> 3 L/day), hypernatremia, and low urine osmolality within the early postoperative period Management: Responded to desmopressin and fluid correction Outcome: Stabilized with no long-term endocrine sequelae Case 2: 19 years/Female Diagnosis: Basifrontal psammomatous meningioma Procedure: Tumor excision Postoperative course: Developed features consistent with central DI including hypotonic polyuria and rising serum sodium Management: Treated with desmopressin and careful fluid-electrolyte monitoring Outcome: Prolonged abulia—3 months—gradual resolution over follow-up Discussion: Postoperative DI is typically associated with pituitary or suprasellar surgery, but these cases highlight its occurrence after: Corpus callosotomy (distant from HPA) Basifrontal tumor surgery (possible hypothalamic/pituitary tract disruption or edema) Mechanisms may include: Transient hypothalamic dysfunction Vascular compromise or surgical traction effects Early recognition is crucial to prevent severe hypernatremia and complications. Conclusion: Central DI can occur even after nonpituitary neurosurgical procedures, including epilepsy surgery. High index of suspicion, early diagnosis, and prompt management are essential for optimal outcomes. Publication History Article published online: 15 July 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Private Limited A-13A, Graphix Tower 1, 6th floor, Sector 62, Noida 201309, Uttar Pradesh, India