Hoefnagel Daphna, Kwee Lesley E, van Putten Erik H P, Kros Johan M, Dirven Clemens M F, Dammers Ruben
Department of Neurosurgery, Erasmus MC, Rotterdam, The Netherlands.
Department of Neurosurgery, Slotervaartziekenhuis, Amsterdam, The Netherlands.
Clin Neurol Neurosurg. 2014 Aug;123:150-4. doi: 10.1016/j.clineuro.2014.06.001. Epub 2014 Jun 11.
Patients with meningiomas carry an increased risk for postoperative venous thromboembolic complications (VTE) including deep venous thrombosis (DVT) and pulmonary embolism (PE).
In the present retrospective study we investigated the incidence of VTE and the risk factors involved, in a large cohort of patients surgically treated for an intracranial meningioma at our institution.
During the period from January 1997 to January 2009, 581 consecutive patients underwent craniotomy for intracranial meningioma. All patients received low-molecular weight heparins as thromboembolism prophylaxis. Patient demographics and tumor characteristics were gathered via retrospective chart review. Postoperative VTE and hemorrhages were noted. Backward stepwise logistic regression was used to determine the risk factors.
80.6% of meningiomas were WHO grade 1; 15.1% WHO grade 2; 4.3% WHO grade 3. Postoperative VTE were observed in 41 patients (7.2%). Of these, DVT was seen in 20 (3.5%) and PE in 26 patients (4.6%). The thromboembolic complication appeared on average 21.1±29.2 days post surgery. The 90-day mortality rate after VTE was 11.2% (23.1% for PE and 5.0% for DVT). Postoperative hemorrhages requiring surgical treatment were found in 2.9% of patients. Risk factors for VTE were body mass index (p=0.015) for DVT; weight (p=0.001) and bedridden postoperatively (p=0.001) for PE; and weight (p=0.004) and bedridden postoperatively (p=0.003) for VTE in general. There was no relation between tumor grade and thromboembolic complications.
The major risk factors for postoperative VTE found in our single center study are patient weight and a bedridden status postoperatively. Prophylactic intervention for this potentially fatal complication should be evaluated against the relative lower risk of postoperative hemorrhages.
脑膜瘤患者术后发生静脉血栓栓塞并发症（VTE）的风险增加，包括深静脉血栓形成（DVT）和肺栓塞（PE）。
在本回顾性研究中，我们调查了在我们机构接受颅内脑膜瘤手术治疗的一大组患者中VTE的发生率及相关危险因素。
在1997年1月至2009年1月期间，581例连续患者接受了颅内脑膜瘤开颅手术。所有患者均接受低分子量肝素预防血栓栓塞。通过回顾病历收集患者人口统计学和肿瘤特征。记录术后VTE和出血情况。采用向后逐步逻辑回归确定危险因素。
80.6%的脑膜瘤为世界卫生组织（WHO）1级；15.1%为WHO 2级；4.3%为WHO 3级。41例患者（7.2%）发生术后VTE。其中，20例（3.5%）出现DVT，26例患者（4.6%）出现PE。血栓栓塞并发症平均出现在术后21.1±29.2天。VTE后90天死亡率为11.2%（PE为23.1%，DVT为5.0%）。2.9%的患者出现需要手术治疗的术后出血。DVT的VTE危险因素为体重指数（p=0.015）；PE的危险因素为体重（p=0.001）和术后卧床（p=0.001）；总体VTE的危险因素为体重（p=0.004）和术后卧床（p=0.003）。肿瘤分级与血栓栓塞并发症之间无关联。
我们单中心研究中发现的术后VTE的主要危险因素是患者体重和术后卧床状态。对于这种潜在致命并发症的预防性干预应根据术后出血相对较低的风险进行评估。
