Abstract：
OBJECTIVE: A cerebellar bulge prior to posterior fossa resection is an emergency condition during surgery. Intraoperative cerebellar bulging not only increases the difficulty of lesion resection but also brings additional postoperative complications. Currently, there are few systematic reports on this topic. The predictors of cerebellar bulge and how to effectively prevent intraoperative cerebellar bulge are discussed in this article.
METHODS: The clinical and imaging data of 527 patients with posterior fossa lesions who underwent resection at our hospital were retrospectively collected and analyzed. Perioperative clinical and imaging data were assessed. Variables were analyzed using univariate and multivariate regression analyses.
RESULTS: Overall, 10.4% (55/527) of patients had intraoperative acute bulges. Multivariate analysis revealed that age <60 years, body mass index ≥24, lesion size ≥30 (mm), cerebellar tonsillar herniation and/or hydrocephalus, and perilesional edema (moderate-severe) were predictors of cerebellar bulging. Relief of the cerebellar bulge can be accomplished by excising the lesion, releasing cerebrospinal fluid, and removing the cerebellum (the outer one-third). Obvious cerebellar-related complications occurred in 4 patients postoperatively, and the symptoms disappeared after 6 months of follow-up.
CONCLUSIONS: Cerebellar bulging during intraoperative posterior fossa resection deserves attention. Through the analysis of multiple factors related to cerebellar bulge, comprehensive evaluation and early intervention during the perioperative period are necessary. The incidence of cerebellar bulges can be reduced, and surgical complications related to cerebellar bulges can be avoided.
METHODS: The clinical and imaging data of 527 patients with posterior fossa lesions who underwent resection at our hospital were retrospectively collected and analyzed. Perioperative clinical and imaging data were assessed. Variables were analyzed using univariate and multivariate regression analyses.
RESULTS: Overall, 10.4% (55/527) of patients had intraoperative acute bulges. Multivariate analysis revealed that age <60 years, body mass index ≥24, lesion size ≥30 (mm), cerebellar tonsillar herniation and/or hydrocephalus, and perilesional edema (moderate-severe) were predictors of cerebellar bulging. Relief of the cerebellar bulge can be accomplished by excising the lesion, releasing cerebrospinal fluid, and removing the cerebellum (the outer one-third). Obvious cerebellar-related complications occurred in 4 patients postoperatively, and the symptoms disappeared after 6 months of follow-up.
CONCLUSIONS: Cerebellar bulging during intraoperative posterior fossa resection deserves attention. Through the analysis of multiple factors related to cerebellar bulge, comprehensive evaluation and early intervention during the perioperative period are necessary. The incidence of cerebellar bulges can be reduced, and surgical complications related to cerebellar bulges can be avoided.
摘要：
目的：后颅窝切除前的小脑膨出是手术中的紧急情况。术中小脑膨出不仅增加了病灶切除的难度，而且还会带来额外的术后并发症。目前,关于这个主题的系统报告很少。本文讨论了小脑膨出的预测因素以及如何有效预防术中小脑膨出。
方法：回顾性分析527例后颅窝病变患者的临床及影像学资料。评估围手术期临床和影像学数据。使用单变量和多变量回归分析对变量进行分析。
结果：总体而言，10.4%(55/527)的患者术中出现急性隆起。多因素分析显示年龄<60岁,BMI≥24，病变大小≥30（mm），小脑扁桃体疝和/或脑积水，和周围水肿（中度-重度）是小脑膨出的预测因素。小脑隆起的缓解可以通过切除病变来实现，释放脑脊液，并去除小脑（外1/3）。4例患者术后出现明显的小脑相关并发症,随访6个月后症状消失。
结论：后颅窝切除术中小脑膨出值得关注。通过对小脑隆起相关多因素的分析,围手术期的综合评估和早期干预是必要的。小脑隆起的发生率可以减少，可以避免与小脑隆起相关的手术并发症。
方法：回顾性分析527例后颅窝病变患者的临床及影像学资料。评估围手术期临床和影像学数据。使用单变量和多变量回归分析对变量进行分析。
结果：总体而言，10.4%(55/527)的患者术中出现急性隆起。多因素分析显示年龄<60岁,BMI≥24，病变大小≥30（mm），小脑扁桃体疝和/或脑积水，和周围水肿（中度-重度）是小脑膨出的预测因素。小脑隆起的缓解可以通过切除病变来实现，释放脑脊液，并去除小脑（外1/3）。4例患者术后出现明显的小脑相关并发症,随访6个月后症状消失。
结论：后颅窝切除术中小脑膨出值得关注。通过对小脑隆起相关多因素的分析,围手术期的综合评估和早期干预是必要的。小脑隆起的发生率可以减少，可以避免与小脑隆起相关的手术并发症。
