目的:择期颅脑手术后的术后管理,特别是在活检手术后,神经外科中心之间差异很大。术后常规头颅CT扫描,传统上进行检测并发症,如颅内出血或脑水肿,缺乏支持其必要性的大量证据。
方法:本研究是一项回顾性队列分析,在2018年至2022年期间,在区域神经外科进行了236例接受脑活检的患者。患者数据,包括人口统计,手术细节,和术后结果,进行了收集和分析。结果调查的是术后CT扫描对出院时间的发生率和影响,管理变革,术前抗凝的影响。
结果:在236名患者中,205例(86.86%)行术后CT扫描。术后血肿、在CT扫描中检测到,和神经功能缺损(p=0.443),或术前抗凝和CT扫描术后出血之间(p=0.464)。与未进行CT扫描的患者相比,进行术后CT扫描的患者的住院时间(LOS)明显更长(p<0.001)。术中出血是术后CT血肿的预测指标(p=0.017),但不是术后神经功能缺损。术后常规CT扫描对症状性缺陷的预测价值有限,阳性预测值为6.67%,阴性预测值为96.88%。
结论:脑活检后的常规术后CT扫描并不显著影响管理或改善患者预后,但与更长的住院时间相关。CT扫描应保留给有并发症临床体征的患者,而不是在脑活检后用作常规程序。
OBJECTIVE: Postoperative management following elective cranial surgery, particularly after biopsy procedures, varies significantly across neurosurgical centres. Routine postoperative head CT scans, traditionally performed to detect complications such as intracranial bleeding or cerebral oedema, lack substantial evidence supporting their necessity.
METHODS: This study is a retrospective cohort analysis conducted at a regional neurosurgical department of 236 patients who underwent brain biopsies between 2018 and 2022. Patient data, including demographics, surgical details, and postoperative outcomes, were collected and analysed. The outcomes investigated were the incidence and impact of postoperative CT scans on time to discharge, management changes, and the influence of preoperative anticoagulation.
RESULTS: Out of 236 patients, 205 (86.86%) underwent postoperative CT scans. There was no significant relationship between postoperative hematoma, as detected on a CT scan, and neurological deficit (p = 0.443), or between preoperative anticoagulation and postoperative bleeding on CT scans (p = 0.464). Patients who had postoperative CT scans had a significantly longer length of stay (LOS) compared to those who did not (p < 0.001). Intraoperative bleeding was a predictor of hematoma on postoperative CT (p = 0.017) but not of postoperative neurological deficit. The routine postoperative CT scan showed limited predictive value for symptomatic deficits, with a positive predictive value of 6.67% and a negative predictive value of 96.88%.
CONCLUSIONS: Routine postoperative CT scans after brain biopsies do not significantly impact management or improve patient outcomes but are associated with longer hospital stays. CT scans should be reserved for patients showing clinical signs of complications rather than used as a routine procedure after a brain biopsy.