Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California, USA.
J Neurosurg. 2011 Mar;114(3):697-704. doi: 10.3171/2010.6.JNS091974. Epub 2010 Jul 23.
While the surgical and neurological risks of meningioma surgery have been reported, much less effort has been devoted to studying the rates of serious medical complications following such a procedure. The authors performed a review of 834 patients who underwent craniotomy for meningioma at their institution and analyzed the rate of major cardiac, pulmonary, renal, and hepatic complications.
The authors identified all patients between 1993 and 2007 who underwent craniotomy for meningioma. Clinical information was reconstructed using patient medical records, medication records, radiological data, and pathological specimens from both the author institution and outside medical facilities. Stepwise multivariate logistic regression analysis was performed to test the association between the dependent variable (rate of medical complications) and all covariates with a p < 0.2 on univariate testing.
Fifty-seven patients (6.8%) experienced 61 serious medical complications following surgery for meningioma. Four patients died of medical complications. The most common complication was pneumonia, followed by renal dysfunction, arrhythmia, and deep venous thrombosis and/or pulmonary embolus. The development of a new or worsened neurological deficit (p < 0.00001), an age > 65 years (p < 0.03), hypertension (p < 0.02), and being on > 2 cardiac medications prior to surgery (p < 0.004) all demonstrated significantly increased rates of medical complications on univariate analysis. On multivariate analysis, only a new or worsened neurological deficit remained a significant risk factor for the occurrence of serious medical complications (p < 0.00001).
Overall, the authors found that the rate of clinically detected serious medical complications is relatively low in this population (6.8%), given the duration and complexity of the meningioma operations, and is strongly linked to the subsequent development of significant medical complications. This information may be useful to surgeons in discussing the morbidity of surgery during the informed consent process.
虽然脑膜瘤手术的外科和神经学风险已有报道，但对于研究此类手术后严重医疗并发症的发生率却关注甚少。作者对在其机构接受开颅手术治疗脑膜瘤的 834 名患者进行了回顾性分析，并分析了主要心脏、肺部、肾脏和肝脏并发症的发生率。
作者确定了 1993 年至 2007 年间在其机构接受开颅手术治疗脑膜瘤的所有患者。使用患者病历、用药记录、影像学数据以及作者机构和其他医疗机构的病理标本重建临床信息。采用逐步多元逻辑回归分析，对依赖变量（医疗并发症发生率）和所有单变量检验 p<0.2 的协变量之间的关系进行检验。
57 例（6.8%）患者在脑膜瘤手术后发生 61 例严重医疗并发症。4 例患者死于医疗并发症。最常见的并发症是肺炎，其次是肾功能障碍、心律失常、深静脉血栓形成和/或肺栓塞。新出现或恶化的神经功能缺损（p<0.00001）、年龄>65 岁（p<0.03）、高血压（p<0.02）和术前使用>2 种心脏药物（p<0.004）在单变量分析中均显示出医疗并发症发生率显著增加。多变量分析显示，只有新出现或恶化的神经功能缺损仍然是发生严重医疗并发症的显著危险因素（p<0.00001）。
总的来说，作者发现该人群中临床发现的严重医疗并发症发生率相对较低（6.8%），考虑到脑膜瘤手术的持续时间和复杂性，且与随后发生的严重医疗并发症密切相关。该信息可能有助于外科医生在知情同意过程中讨论手术的发病率。
