Linzey Joseph R, Wilson Thomas J, Sullivan Stephen E, Thompson B Gregory, Pandey Aditya S
University of Michigan Medical School, Ann Arbor, Michigan.
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
Neurosurgery. 2017 Sep 1;81(3):504-511. doi: 10.1093/neuros/nyx046.
Frontotemporal craniotomies are commonly performed for a variety of neurosurgical pathologies. Infections related to craniotomies cause significant morbidity. We hypothesized that the risk of cranial surgical site infections (SSIs) may be increased in patients whose frontal sinuses are breached during craniotomy.
To compare the rate of cranial SSIs in patients undergoing frontotemporal craniotomies with and without frontal sinus breach (FSB).
We performed a retrospective analysis of all patients undergoing frontotemporal craniotomies for the management of cerebral aneurysms from 2005 to 2014. This study included 862 patients undergoing 910 craniotomies. Primary outcome of interest was occurrence of a cranial SSI. Standard statistical methods were utilized to explore associations between a variety of variables including FSB, cranial SSI, and infections requiring reoperation.
Of the 910 craniotomies, 141 (15.5%) involved FSB. Of those involving FSB, 22 (15.6%) developed a cranial SSI, compared to only 56 of the 769 without FSB (7.3%; P = .001). Cranial SSI requiring reoperation was much more likely in patients with FSB compared to those without a breach (7.8% vs 1.6%; P < .001). In those presenting with cranial SSIs, epidural abscess formation was more common with FSB compared to no FSB (27.3% vs 5.4%; P = .006). In multivariate analysis, breach of the frontal sinus was significantly associated with cranial SSI (OR 2.16; 95% CI 1.24-3.78; P = .01) and reoperation (OR 4.20; 95% CI 1.66-10.65; P = .003).
Patients undergoing frontotemporal craniotomies are at significantly greater risk of serious cranial SSIs if the frontal sinus has been breached.
额颞开颅手术常用于多种神经外科疾病的治疗。开颅手术相关感染会导致严重的发病情况。我们推测，开颅手术过程中额窦被破坏的患者发生颅骨手术部位感染（SSIs）的风险可能会增加。
比较有和没有额窦破裂（FSB）的患者在接受额颞开颅手术后颅骨SSIs的发生率。
我们对2005年至2014年期间所有因治疗脑动脉瘤而接受额颞开颅手术的患者进行了回顾性分析。本研究纳入了862例患者，共进行了910次开颅手术。主要关注的结果是颅骨SSI的发生情况。采用标准统计方法探讨包括FSB、颅骨SSI和需要再次手术治疗的感染等多种变量之间的关联。
在910次开颅手术中，141次（15.5%）涉及FSB。在涉及FSB的手术中，22例（15.6%）发生了颅骨SSI，而在769例未发生FSB的手术中，只有56例（7.3%）发生了颅骨SSI（P = 0.001）。与未发生额窦破裂的患者相比，发生FSB的患者因颅骨SSI需要再次手术的可能性要大得多（7.8%对1.6%；P < 0.001）。在发生颅骨SSI的患者中，与未发生FSB的患者相比，FSB患者硬膜外脓肿形成更为常见（27.3%对5.4%；P = 0.006）。多因素分析显示，额窦破裂与颅骨SSI（比值比2.16；95%可信区间1.24 - 3.78；P = 0.01）和再次手术（比值比4.20；95%可信区间1.66 - 10.65；P = 0.003）显著相关。
如果额窦已被破坏，接受额颞开颅手术的患者发生严重颅骨SSIs的风险会显著增加。
