Department of Neurosurgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama, USA.
Department of Neurosurgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama, USA.
World Neurosurg. 2018 Jan;109:e731-e738. doi: 10.1016/j.wneu.2017.10.073. Epub 2017 Oct 23.
Open surgical access to the posterior fossa traditionally has been achieved by permanent bone removal and remains the mainstay of posterior fossa surgery, although craniotomy is an alternative. Considerable variation exists at both the national and international levels within a variety of neurologic and neurosurgical disciplines. In this study, we surveyed current practice patterns regarding preference of suboccipital craniotomy or craniectomy.
The membership directory of the American Academy of Neurological Surgeons was reviewed. SurveyMonkey was used to distribute the survey to members of the American Academy of Neurological Surgeons via a modified Dillman method for e-mail correspondence. Comparisons of frequency distributions, means, and medians, as well as multiple logistic regression were used to determine surgical preferences for craniotomy versus craniectomy.
We received 1102 responses (19.6%). Overall, 542 (49.7%) respondents prefer craniotomy and 548 (50.3%) prefer craniectomy. Respondents who prefer craniotomy had completed a residency more recently than respondents who preferred craniectomy (15.9 vs. 21.1 years, P < 0.0001) and were more likely to practice outside of North America (P < 0.01). Some 81.4% of pediatric neurosurgeons prefer craniotomy compared with 43.6% of adult neurosurgeons (P < 0.0001). Craniotomy was most highly preferred for tumor resection and vascular malformation. Within the United States, there was significant variation in preference for craniotomy based on geographic region, with New England most commonly preferring craniotomy and the Mid-Atlantic region most commonly preferring craniectomy.
Our results show that preference for suboccipital craniotomy or craniectomy varies according to geographic location of practice, time since completing residency, and age of patient population.
传统上，通过永久性骨切除来获得对后颅窝的开放式手术入路，这仍然是后颅窝手术的主要方法，尽管开颅术是一种替代方法。在各种神经学和神经外科学科中，国家和国际层面都存在相当大的差异。在这项研究中，我们调查了目前关于选择枕下颅切开术或颅切除术的偏好的实践模式。
审查了美国神经外科学院的会员名录。使用 SurveyMonkey 通过修改后的电子邮件通讯的 Dillman 方法向美国神经外科学院的成员发送了该调查。使用频率分布、均值和中位数的比较以及多元逻辑回归来确定颅切开术与颅切除术的手术偏好。
我们收到了 1102 份回复（19.6%）。总体而言，542 名（49.7%）受访者更喜欢颅切开术，而 548 名（50.3%）更喜欢颅切除术。与更喜欢颅切除术的受访者相比，更喜欢颅切开术的受访者完成住院医师培训的时间更新（15.9 年对 21.1 年，P<0.0001），并且更有可能在北美以外的地方行医（P<0.01）。81.4%的小儿神经外科医生更喜欢颅切开术，而只有 43.6%的成人神经外科医生更喜欢颅切除术（P<0.0001）。颅切开术最常用于肿瘤切除术和血管畸形。在美国，基于地理位置，对颅切开术的偏好存在显著差异，新英格兰地区最常选择颅切开术，而大西洋中部地区最常选择颅切除术。
我们的结果表明，对枕下颅切开术或颅切除术的偏好根据实践地理位置、完成住院医师培训后的时间以及患者人群的年龄而有所不同。
