Kuan Edward C, Rereddy Shruthi K, Patel Neil N, Maina Ivy W, Triantafillou Vasiliki, Kohanski Michael A, Tong Charles C L, Nabavizadeh Seyed A, Lee John Y K, Grady M Sean, O'Malley Bert W, Palmer James N, Adappa Nithin D
Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California.
Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
Laryngoscope. 2019 Jul;129(7):1545-1548. doi: 10.1002/lary.27893. Epub 2019 Mar 5.
Chronic rhinosinusitis (CRS) is a proposed risk factor for meningitis and other intracranial complications following the endoscopic endonasal transsphenoidal approach (TSA). Some have recommended staging TSA following surgery for CRS; however, delaying TSA has important ramifications. The objective of this study is to determine whether asymptomatic sinonasal inflammation (RSNI) on preoperative computed tomography scans, without clinical CRS, is associated with postoperative complications following TSA.
All consecutive TSA cases performed at a single tertiary care institution from January 1, 2009, to December 31, 2017, were reviewed for patient demographics, prior surgery, presence of RSNI on preoperative computed tomography scan based on Lund-Mackay (LM) score, intraoperative cerebrospinal fluid (CSF) leak, and postoperative complications (postoperative CSF leak, bleeding, infection). The association between preoperative RSNI and postoperative complications was analyzed via multivariate logistic regression.
One hundred seventy-one cases of TSA were included with mean patient age of 52.6 years, 42.7% males, 18.1% revision cases, and mean LM score of 1.9 ± 2.7. Complications were identified in 9.9% of patients at the following rates: 5.3% postoperative CSF leak, 2.9% bleeding, and 1.8% infection (all sinusitis, no episodes of meningitis). Neither total LM score nor LM score > 5 (representative of clinically significant radiographic CRS) were predictors of any postoperative complication (both P > 0.05). Age, sex, revision status, intraoperative CSF leak, and total LM score were not independent predictors of any postoperative complication on multivariate analysis (all P > 0.05).
In asymptomatic patients, radiographic evidence of sinonasal inflammation is not associated with increased risk of complications following TSA.
4 Laryngoscope, 129:1545-1548, 2019.
慢性鼻-鼻窦炎（CRS）被认为是鼻内镜下经鼻蝶窦入路（TSA）术后发生脑膜炎及其他颅内并发症的危险因素。一些人建议在CRS手术后对TSA进行分期；然而，推迟TSA有重要影响。本研究的目的是确定术前计算机断层扫描（CT）上无症状的鼻-鼻窦炎症（RSNI），无临床CRS，是否与TSA术后并发症相关。
回顾了2009年1月1日至2017年12月31日在一家三级医疗机构连续进行的所有TSA病例，记录患者人口统计学资料、既往手术史、根据Lund-Mackay（LM）评分在术前CT扫描上RSNI的存在情况、术中脑脊液（CSF）漏以及术后并发症（术后CSF漏、出血、感染）。通过多因素逻辑回归分析术前RSNI与术后并发症之间的关联。
纳入171例TSA病例，患者平均年龄52.6岁，男性占42.7%，翻修病例占18.1%，平均LM评分为1.9±2.7。9.9%的患者出现并发症，发生率如下：术后CSF漏5.3%，出血2.9%，感染1.8%（均为鼻窦炎，无脑膜炎病例）。总LM评分和LM评分>5（代表具有临床意义的影像学CRS）均不是任何术后并发症的预测因素（P均>0.05）。在多因素分析中，年龄、性别、翻修状态、术中CSF漏和总LM评分均不是任何术后并发症的独立预测因素（P均>0.05）。
在无症状患者中，鼻-鼻窦炎症的影像学证据与TSA术后并发症风险增加无关。
4 《喉镜》，2019年，第129卷，第1545 - 1548页
