Copeland William R, Mallory Grant W, Neff Brian A, Driscoll Colin L W, Link Michael J
Departments of 1 Neurologic Surgery and.
J Neurosurg. 2015 Feb;122(2):312-6. doi: 10.3171/2014.10.JNS14432. Epub 2014 Nov 21.
The following study was conducted to identify risk factors for a postoperative CSF leak after vestibular schwannoma (VS) surgery.
The authors reviewed a prospectively maintained database of all patients who had undergone resection of a VS at the Mayo Clinic between September 1999 and May 2013. Patients who developed a postoperative CSF leak within 30 days of surgery were compared with those who did not. Data collected included patient age, sex, body mass index (BMI), tumor size, tumor side, history of prior tumor treatment, operative time, surgical approach, and extent of resection. Both univariate and multivariate regression analyses were performed to evaluate all variables as risk factors of a postoperative CSF leak.
A total of 457 patients were included in the study, with 45 patients (9.8%) developing a postoperative CSF leak. A significant association existed between increasing BMI and a CSF leak, with those classified as overweight (BMI 25-29.9), obese (BMI 30-39.9), or morbidly obese (BMI≥40) having a 2.5-, 3-, and 6-fold increased risk, respectively. Patients undergoing a translabyrinthine (TL) approach experienced a higher rate of CSF leaks (OR 2.5, 95% CI 1.3-4.6; p=0.005), as did those who had longer operative times (OR 1.04, 95% CI 1.02-1.07; p=0.0006). The BMI, a TL approach, and operative time remained independent risk factors on multivariate modeling.
Elevated BMI is a risk factor for the development of a postoperative CSF leak following VS surgery. Recognizing this preoperatively can allow surgeons to better counsel patients regarding the risks of surgery as well as perhaps to alter perioperative management in an attempt to decrease the likelihood of a leak. Patients undergoing a TL approach or having longer operative times are also at increased risk of developing a postoperative CSF leak.
进行以下研究以确定前庭神经鞘瘤（VS）手术后发生脑脊液漏的危险因素。
作者回顾了1999年9月至2013年5月在梅奥诊所接受VS切除术的所有患者的前瞻性维护数据库。将术后30天内发生脑脊液漏的患者与未发生的患者进行比较。收集的数据包括患者年龄、性别、体重指数（BMI）、肿瘤大小、肿瘤侧别、既往肿瘤治疗史、手术时间、手术入路和切除范围。进行单因素和多因素回归分析以评估所有变量作为术后脑脊液漏的危险因素。
该研究共纳入457例患者，其中45例（9.8%）发生术后脑脊液漏。BMI增加与脑脊液漏之间存在显著关联，超重（BMI 25 - 29.9）、肥胖（BMI 30 - 39.9）或病态肥胖（BMI≥40）的患者发生脑脊液漏的风险分别增加2.5倍、3倍和6倍。采用经迷路（TL）入路的患者脑脊液漏发生率较高（OR 2.5，95% CI 1.3 - 4.6；p = 0.005），手术时间较长的患者也是如此（OR 1.04，95% CI 1.02 - 1.07；p = 0.0006）。在多因素模型中，BMI、TL入路和手术时间仍然是独立的危险因素。
BMI升高是VS手术后发生术后脑脊液漏的危险因素。术前认识到这一点可以使外科医生更好地向患者咨询手术风险，或许还可以改变围手术期管理，以降低脑脊液漏的可能性。采用TL入路或手术时间较长的患者发生术后脑脊液漏的风险也会增加。
