背景:术后脑脊液(CSF)漏仍然是内镜经鼻入路(EEA)治疗颅底病理学的一个值得关注的并发症。提示CSF泄漏的体征和症状通常会在术后过程中引发额外的检查。我们系统地评估了术后即刻记录的主观报告的临床体征/症状与术后脑脊液漏发生率之间的关联。
方法:回顾性图表审查在三级学术医疗中心进行,包括137名在2018年7月至2022年8月期间在EEA期间进行初次修复的术中CSF泄漏的连续患者。使用阳性预测值(PPV)和阴性预测值(NPV)评估术后CSF泄漏与临床体征和症状的关联。灵敏度,特异性和比值比(OR)通过单变量逻辑回归。
结果:79例患者(57.7%)高流量渗漏修复,5例(3.6%)术后出现脑脊液渗漏。在报告的症状中,鼻漏最为常见(n=52,38.0%;PPV[95%CI]=7.6%[4.8%,11.9%]),其次是严重头痛(n=47,34.3%;6.3%[3.1%,12.5%]),头晕(n=43,31.4%;2.3%[0.4%,12.1%]),咸或金属味(n=20,14.6%;9.9%[3.3%,25.8%]),和咽喉引流(n=10,7.3%;9.9%[1.7%,41.4%])。恶心或呕吐是脑脊液漏出最多的症状(n=73,53.3%;PPV[95%CI]=4.1%[2.0%,8.1%])。在单变量回归中,没有迹象或症状,包括鼻漏(OR[95%CI]=7.00[0.76-64.44]),喉部引流(3.42[0.35-33.86]),咸/金属味(4.22[0.66-27.04]),严重头痛(3.00[0.48-18.62]),头晕(0.54[0.06-4.94]),发烧(3.16[0.50-19.99]),恶心/呕吐(1.33[0.22-8.21]),与术后脑脊液漏有关。
结论:一系列主观报告的症状和体征未能预测术后脑脊液漏。需要进一步调查,以告知适当的关注和回应。
BACKGROUND: Postoperative cerebrospinal fluid (CSF) leak remains a concerning complication of the endoscopic endonasal approach (EEA) for skull base pathology. Signs and symptoms suggesting CSF leak often trigger additional workup during the postoperative course. We systematically evaluate associations between subjectively reported clinical signs/symptoms noted during the immediate postoperative period and incidence of postoperative CSF leaks.
METHODS: Retrospective chart review was conducted at a tertiary academic medical centre including 137 consecutive patients with intraoperative CSF leak during EEA with primary repair between July 2018 and August 2022. Postoperative CSF leak associations with clinical signs and symptoms were evaluated using positive (PPV) and negative predictive values (NPV), sensitivity, specificity and odds ratio (OR) via univariate logistic regression.
RESULTS: Seventy-nine patients (57.7%) had high-flow leaks repaired and 5 (3.6%) developed CSF leaks postoperatively. Of reported symptoms, rhinorrhea was most common (n = 52, 38.0%; PPV [95% CI] = 7.6% [4.8%, 11.9%]), followed by severe headache (n = 47, 34.3%; 6.3% [3.1%, 12.5%]), dizziness (n = 43, 31.4%; 2.3% [0.4%, 12.1%]), salty or metallic taste (n = 20, 14.6%; 9.9% [3.3%, 25.8%]), and throat drainage (n = 10, 7.3%; 9.9% [1.7%, 41.4%]). Nausea or vomiting constituted the most reported sign concerning for CSF leak (n = 73, 53.3%; PPV [95% CI] = 4.1% [2.0%, 8.1%]). On univariate regression, no sign or symptom, including rhinorrhea (OR [95% CI] = 7.00 [0.76-64.44]), throat drainage (3.42 [0.35-33.86]), salty/metallic taste (4.22 [0.66-27.04]), severe headache (3.00 [0.48-18.62]), dizziness (0.54 [0.06-4.94]), fever (3.16 [0.50-19.99]), and nausea/vomiting (1.33 [0.22-8.21]), associated with postoperative CSF leak.
CONCLUSIONS: A range of subjectively reported symptoms and signs failed to predict postoperative CSF leak. Further investigation is warranted to inform appropriate attention and response.