Steinbok P, Singhal A, Mills J, Cochrane D D, Price A V
Division of Pediatric Neurosurgery, Department of Pediatric Surgery, British Columbia's Children's Hospital, Children's and Women's Health Centre, 4480 Oak Street, #K3-159, Vancouver V6H 3V4, BC, Canada.
Childs Nerv Syst. 2007 Feb;23(2):171-4; discussion 175. doi: 10.1007/s00381-006-0234-0. Epub 2006 Sep 19.
The purpose of this study was to determine the incidence of pseudomeningocele and cerebrospinal fluid (CSF) leak after posterior fossa tumor surgery and to analyze factors that may be associated with these conditions. In particular, we wished to determine if there was evidence to support the hypothesis that the use of tissue glue, dural grafts, or external ventricular drainage (EVD) prevented CSF from leaking outside the closed dura.
A retrospective chart review was carried out of posterior fossa tumor resections at British Columbia's Children's Hospital. Information was collected regarding tumor location, surgical approach, CSF diversion, dural grafting, and use of tissue glue. Multiple univariate analyses and step-wise logistic regression were performed to identify factors associated with pseudomeningocele formation or CSF leak. A pseudomeningocele was said to be present if it was noted in the clinical records or if a fluid collection was present superficial to the craniotomy flap on a postoperative CT or MR scan.
Out of 174 posterior fossa operations, 53 pseudomeningoceles with or without CSF leak were identified along with five CSF leaks in the absence of pseudomeningocele (33%). None of the factors examined reached statistical significance, although there was a trend towards higher rates in patients with external CSF drainage (P=0.06631), dural graft usage (p=0.06492), and patients in whom tissue glue was used (p=0.06181). On logistic regression, only tissue glue use and external CSF drainage were associated with increased incidence of pseudomeningocele and/or CSF leak.
In this retrospective study, the use of tissue glue, dural grafts, and external ventricular drainage was not associated with a reduced rate of clinically or radiologically diagnosed pseudomeningocele formation or postoperative CSF leak. The results of this study provide a basis for planning a randomized controlled trial to determine the effectiveness of tissue glue and/or dural grafting in preventing these complications.
本研究旨在确定后颅窝肿瘤手术后假性脑脊膜膨出和脑脊液（CSF）漏的发生率，并分析可能与这些情况相关的因素。特别是，我们希望确定是否有证据支持以下假设：使用组织胶水、硬脑膜移植片或外部脑室引流（EVD）可防止脑脊液漏出封闭的硬脑膜外。
对不列颠哥伦比亚省儿童医院的后颅窝肿瘤切除术进行回顾性病历审查。收集有关肿瘤位置、手术入路、脑脊液分流、硬脑膜移植和组织胶水使用情况的信息。进行了多项单因素分析和逐步逻辑回归，以确定与假性脑脊膜膨出形成或脑脊液漏相关的因素。如果临床记录中有记载，或者术后CT或MR扫描显示开颅皮瓣表面有液体积聚，则认为存在假性脑脊膜膨出。
在174例后颅窝手术中，共发现53例假性脑脊膜膨出（伴或不伴有脑脊液漏）以及5例无假性脑脊膜膨出的脑脊液漏（33%）。尽管接受外部脑脊液引流的患者（P=0.06631）、使用硬脑膜移植片的患者（P=0.06492）和使用组织胶水的患者（P=0.06181）的发生率有升高趋势，但所检查的因素均未达到统计学意义。在逻辑回归分析中，只有组织胶水的使用和外部脑脊液引流与假性脑脊膜膨出和/或脑脊液漏的发生率增加有关。
在这项回顾性研究中，使用组织胶水、硬脑膜移植片和外部脑室引流与临床或影像学诊断的假性脑脊膜膨出形成率或术后脑脊液漏率降低无关。本研究结果为规划一项随机对照试验提供了依据，以确定组织胶水和/或硬脑膜移植在预防这些并发症方面的有效性。
