背景:在经callosal手术切除肿瘤后,凸面或半球间硬膜下脑脊液集合的形成可能导致临床恶化,并可能影响有关其他干预措施的决策.这项研究的目的是确定发病率,危险因素,以及在儿科队列中经call入路后硬膜下收集的管理。
方法:在一个单中心三级儿科神经外科病房进行了12年(2012-2023年)的回顾性病例记录和放射学回顾。参数包括人口统计和临床信息,包括病变位置,病理学,切除范围,所需分流器的需求和类型,以及深度,偏侧性,在调车之前分析了集合的位置,大约3周时,3个月,以及术后可用的最新随访,以进一步阐明这些硬膜下集合的自然史及其临床意义。
结果:64例符合经颅骨手术切除肿瘤的纳入标准;13例没有足够的术后影像学检查,被排除在外。在剩下的51个案例中,有32名儿童(63%)术后脑脊液硬膜下收集,其中59%为同侧,其余为双边分布。在3个月时,总的分流插入率为25.5%(12脑室腹膜和1硬膜下腹膜分流),术后平均分流时间为19天。术后出现硬膜下集合的儿童分流率较高,37.5%,相比之下,那些没有这样做的人的比例为5.2%。术前和术后脑积水和次全切除术被确定为术后硬膜下集合发展的危险因素。硬膜下收集显示出自然的减少和消退过程,除了3个孩子,他们坚持或随着时间的推移增加;虽然这些都不需要分流。与非分流组相比,那些接受分流插入的儿童随着时间的推移,硬膜下集合的大小表现出更大的回归。
结论:在这个儿科队列中,25.5%的儿童在经call手术后3个月内需要插入分流器。术前和术后脑积水和肿瘤次全切除术是术后硬膜下集合发展的危险因素。
BACKGROUND: Following transcallosal surgery for tumour resection, the formation of convexity or interhemispheric subdural cerebrospinal fluid collections may lead to clinical deterioration and may influence decision-making with regards to additional interventions. The aim of this study was to determine the incidence, risk factors, and management of subdural collections following the transcallosal approach in a paediatric cohort.
METHODS: A retrospective case note and radiological review of all children who underwent transcallosal surgery for intraventricular and thalamic tumours was carried out covering a 12-year period (2012-2023) in a single-centre tertiary paediatric neurosurgery unit. Parameters including demographics and clinical information including lesion location, pathology, extent of resection, need for and type of shunt required, as well as depth, laterality, and location of the collection were analysed prior to shunting, and at approximately 3 weeks, 3 months, and latest follow-up available post-operatively in order to further elucidate the natural history of these subdural collections and their clinical significance.
RESULTS: Sixty-four cases satisfied the inclusion criteria of transcallosal surgery for tumour resection; 13 did not have adequate post-operative imaging and were excluded. Of the remaining 51 cases, there were 32 children (63%) with post-operative CSF subdural collections, of which 59% were ipsilateral, with the remainder showing bilateral distribution. The overall shunt insertion rate was 25.5% (12 ventriculoperitoneal and 1 subdural-peritoneal shunt) at 3 months, with a mean time to shunting of 19 days post-operatively. Children who developed post-operative subdural collections had a higher rate of shunting, at 37.5%, compared to 5.2% in those who did not. Pre- and post-operative hydrocephalus and subtotal resection were identified as risk factors for development of subdural collections post-operatively. Subdural collections showed a natural course of reduction and regression over follow-up, with the exception of 3 children where they persisted or increased over time; although none of these required shunting. Those children who underwent shunt insertion showed greater regression in the size of the subdural collection over time compared to the non-shunted group.
CONCLUSIONS: In this paediatric cohort, 25.5 % of children required insertion of a shunt by 3 months following transcallosal surgery. Pre- and post-operative hydrocephalus and subtotal tumour resection were risk factors for development of subdural collections post-operatively.