目的:分析小脑桥脑角手术患者半位相关的主要并发症。
方法:回顾性分析接受半位肿瘤小脑桥脑角手术的患者的资料。发病率,严重程度,发生时刻,治疗,持续时间,和静脉空气栓塞(VAE)的结果,气颅,体位性低血压,并记录其他并发症。神经重症监护病房(NICU),停留时间(LOS)医院LOS,术后6个月计算改良Rankin量表评分。
结果:50例患者接受了手术。肿瘤切除期间有11例(22%)出现VAE(平均持续时间8±4.5分钟):5例(10%),和四个(8%)在硬脑膜开放。十个(20%)通过覆盖手术床解决,气泡抽吸,颈静脉压迫,一个(2%)倾斜到陡峭的特伦德伦堡位置。1例(2%)术中血流动力学不稳定。与VAE相关的唯一变量是组织病理学上的脑膜瘤OR=4.58,P=0.001。VAE患者的NICU较高(5.5±1.06vs.1.9±0.20天,P=0.01)。Rankin量表没有差异。所有患者术后均表现为气颅,意识水平良好,除了一名(2%)需要疏散的人。7例患者(14%)出现体位性低血压,三个(6%)在定位后,和一个(2%)在发生VAE后;所有都被常规的血管活性药物逆转。在该系列中没有其他位置相关的并发症或死亡率。
结论:根据知识,半姿势是一个安全的选择,预防,检测,并尽早解决所有可能的并发症。VAE的发展很少意味着手术后的血流动力学不稳定或更大的残疾。术后气颅非常常见,很少需要疏散。麻醉之间的良好合作,护理,神经生理学,和神经外科团队是必不可少的管理并发症。
To analyze the primary complications related to semisitting position in patients undergoing cerebelo-pontine angle surgery.
Retrospective data analysis from patients undergoing elective tumoral cerebelo-pontine angle surgery in a semisitting position. The incidence, severity, occurrence moment, treatment, duration, and outcomes of venous air embolism (VAE), pneumocephalus, postural hypotension, and other complications were recorded. Neurointensive care unit (NICU), length of stay (LOS), hospital LOS, and modified Rankin scale scores were calculated six months after surgery.
Fifty patients were operated on. Eleven (22%) presented VAE (mean duration 8±4.5min): five (10%) during tumor resection, and four (8%) during dural opening. Ten (20%) were resolved by covering the surgical bed, air bubbles aspiration, jugular compression, and one (2%) tilted to a steep Trendelenburg position. One (2%) had intraoperative hemodynamic instability. The only variable associated with VAE was meningioma at histopathology OR=4.58, p=0.001. NICU was higher in patients with VAE (5.5±1.06 vs. 1.9±0.20 days, p=0.01). There were no differences in the Rankin scale. All patients presented postoperative pneumocephalus with a good level of consciousness, except one (2%) who required evacuation. Seven patients (14%) showed postural hypotension, three (6%) after positioning, and one (2%) after developing a VAE; all were reversed with usual vasoactive drugs. No other position-related complications or mortality were registered in this series.
The semisitting position is a safe option with the knowledge, prevention, detection, and early solution of all the possible complications. The development of VAE rarely implies hemodynamic instability or greater disability after surgery. Postoperative pneumocephalus is very common and rarely requires evacuation. Excellent cooperation between anesthesia, nursing, neurophysiology, and neurosurgery teams is essential to manage complications.