介绍中颅窝开颅术(MFC)通常用于自发性脑脊液(CSF)泄漏,脑囊肿,和上半规管裂开(SSCD)。这项研究比较了使用和不使用LD的MFC的术后结果。方法对18岁以上的成人进行回顾性队列研究,以修复非肿瘤性CSF漏。脑膨出,或从2009年到2021年通过MFC进行SSCD。感兴趣的主要暴露是LD的放置。主要结果是术后并发症的存在(急性/迟发性神经功能缺损,脑膜炎,颅内出血,和中风)。次要结果包括手术室(OR)时间,逗留时间,复发,需要重新手术。结果总计,包括172名患者,其中96人获得了LD,76人没有。未接受LD的患者更有可能接受术中甘露醇(n=24,31.6%vs.n=16,16.7%,p=0.02)。在单变量逻辑回归中,LD放置不影响术后总并发症(OR:0.38,95%置信区间[CI]:0.05-2.02,p=0.28),脑脊液漏复发(OR:0.75,95%CI:0.25-2.29,p=0.61),或需要再次手术(OR:1.47,95%CI:0.48-4.96,p=0.51)。而未接受LD的患者的OR时间较短(349±71vs.372±85分钟),这一差异无统计学意义(p=0.07).结论术中放置LD的患者与没有LD的患者相比,术后结局没有差异。LD队列的手术时间增加,但这种差异没有统计学意义。鉴于类似的结果,我们得出的结论是,LD对于促进非肿瘤性颅底病变的安全MCF不是必需的。
Introduction The middle fossa craniotomy (MFCs) is commonly utilized for spontaneous cerebrospinal fluid (CSF) leaks, encephaloceles, and superior semicircular canal dehiscence (SSCD). This study compares postoperative outcomes of MFCs with and without LD use. Methods A retrospective cohort study of adults over the age of 18 years presenting for the repair of nonneoplastic CSF leak,
encephalocele, or SSCD via MFC from 2009 to 2021 was conducted. The main exposure of interest was the placement of an LD. The primary outcome was the presence of postoperative complications (acute/delayed neurologic deficit, meningitis, intracranial hemorrhage, and stroke). Secondary outcomes included operating room (OR) time, length of stay, recurrence, and need for reoperation. Results In total, 172 patients were included, 96 of whom received an LD and 76 who did not. Patients not receiving an LD were more likely to receive intraoperative mannitol ( n = 24, 31.6% vs. n = 16, 16.7%, p = 0.02). On univariate logistic regression, LD placement did not influence overall postoperative complications (OR: 0.38, 95% confidence interval [CI]: 0.05-2.02, p = 0.28), CSF leak recurrence (OR: 0.75, 95% CI: 0.25-2.29, p = 0.61), or need for reoperation (OR: 1.47, 95% CI: 0.48-4.96, p = 0.51). While OR time was shorter for patients not receiving LD (349 ± 71 vs. 372 ± 85 minutes), this difference was not statistically significant ( p = 0.07). Conclusion No difference in postoperative outcomes was observed in patients who had an intraoperative LD placed compared to those without LD. Operative times were increased in the LD cohort, but this difference was not statistically significant. Given the similar outcomes, we conclude that LD is not necessary to facilitate safe MCF for nonneoplastic skull base pathologies.