目的:脑积水是儿童脑肿瘤的常见合并症,在脑肿瘤切除后可能持续存在。本研究旨在探讨与位于或邻近CSF循环通路的肿瘤术后脑室-腹腔分流术(VPS)放置相关的围手术期危险因素。
方法:在2015年10月至2021年9月期间接受脑肿瘤切除术的0-18岁肿瘤侵犯或邻近脑脊液循环通路的患者被纳入本研究。结果指标是患者在肿瘤切除后6个月内是否接受了VPS放置。术后每3~6个月对患者进行随访。人口统计学和围手术期影像学特征,临床变量,和长期治疗,包括放疗或化疗,包括在分析中。
结果:这项研究纳入了两百六十五名儿童。在这些病人中,38例(14.34%)在肿瘤切除后6个月内接受了VPS放置。132例患者(49.81%)出现术前脑积水。多因素分析结果显示髓母细胞瘤(OR4.15,95%CI1.74-9.91,p=0.001),侧脑室/第三脑室肿瘤(OR4.07,95%CI1.33-12.30,p=0.014),术后脑室血肿(OR3.36,95%CI1.53-7.38,p=0.003),肿瘤切除后48小时内非手术区存在硬膜下积液(OR2.78,95%CI1.15-6.74,p=0.024)是术后VPS放置的独立危险因素。
结论:非手术区术后侧脑室/第三脑室血肿和硬膜下潮瘤,解剖位置,肿瘤组织学可能是脑肿瘤切除术后VPS的潜在危险因素。
OBJECTIVE: Hydrocephalus is a common comorbidity of brain tumors in children that may persist following brain tumor resection. This study aimed to explore perioperative risk factors associated with postoperative ventriculoperitoneal shunt (VPS) placement for tumors located at or adjacent to the CSF circulation pathway.
METHODS: Patients aged 0-18 years with tumors invading or adjacent to the CSF circulation pathways who underwent brain tumor resection between October 2015 and September 2021 were included in this study. The outcome metric was whether patients underwent VPS placement within 6 months of tumor resection. Patients were followed up every 3-6 months after surgery. Demographic and perioperative imaging characteristics, clinical variables, and long-term treatments, including radiotherapy or chemotherapy, were included in the analysis.
RESULTS: Two hundred sixty-five children were included in this study. Of these patients, 38 (14.34%) underwent VPS placement within 6 months of tumor resection. One hundred thirty-two patients (49.81%) presented with preoperative hydrocephalus. Results from the multivariate analysis showed that medulloblastoma (OR 4.15, 95% CI 1.74-9.91, p = 0.001), lateral/third ventricle tumors (OR 4.07, 95% CI 1.33-12.30, p = 0.014), postoperative intraventricular hematoma (OR 3.36, 95% CI 1.53-7.38, p = 0.003), and presence of subdural hygroma in the nonoperated area within 48 hours after tumor resection (OR 2.78, 95% CI 1.15-6.74, p = 0.024) were independent risk factors for postoperative VPS placement.
CONCLUSIONS: Postoperative lateral/third ventricle hematoma and subdural hygroma in the nonoperated area, anatomical location, and tumor histology may be potential risk factors for a postoperative VPS after brain tumor resection.