Department of Neurosurgery, Virginia Commonwealth University, 417 North 11th Street, Sixth Floor, P.O. Box 980631, Richmond, VA, 23219-0631, USA.
Department of Physiology and Biophysics, Virginia Commonwealth University, 1101 East Marshall Street, P.O. Box 980551, Richmond, VA, 23298-0551, USA.
J Neurooncol. 2019 Aug;144(1):117-125. doi: 10.1007/s11060-019-03209-9. Epub 2019 Jun 21.
Craniopharyngiomas occur in suprasellar locations that pose challenges for surgical management. This study evaluates the incidence of complications following craniotomy for craniopharyngioma in adults and investigates risk factors for these complications.
Patients who underwent craniotomy for excision of craniopharyngioma were identified from the 2005-2016 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Incidence of 30-day postoperative complications was determined. Multivariable logistic regression identified demographic, comorbid and perioperative characteristics associated with any complication and major (Clavien IV) complications. RESULTS: There were 143 cases identified. Fifty-one (35.7%) had a complication, twenty (14.0%) experienced a major complication and there were four (2.8%) deaths. The most common complications were: unplanned readmission (13.3%), prolonged ventilation > 48 h (9.8%), and unplanned reoperation (9.3%). In multivariable analysis, variables significantly associated with any complication were: black race (OR 0.16; 95% CI 0.03-0.84; p = 0.03), hypertension (OR 5.04; 95% CI 1.79-14.17; p = 0.002) and longer duration of surgery (OR 1.27; 95% CI 1.01-1.58; p = 0.04). Hypertension (OR 9.33; 95% CI 1.61-54.21; p = 0.01) and longer duration of surgery (OR 1.51; 95% CI 1.05-2.17; p = 0.03) were also significant predictors for major complications.
One-third of patients undergoing craniotomy for craniopharyngioma resection experienced a postoperative complication. While high, this contrasts previously reported rates of two-thirds. Prolonged operative time and hypertension are positive predictors of major complications. This information can assist in counseling patients and decision-making for management. We note that other treatment approaches, such as endoscopic surgical techniques, radiosurgery and radiation therapy likely have different profiles and predictors of complications.
颅咽管瘤发生于鞍上部位，给手术治疗带来挑战。本研究评估成人颅咽管瘤切除术开颅术后并发症的发生率，并探讨这些并发症的危险因素。
从 2005 年至 2016 年美国外科医师学会国家外科质量改进计划（ACS-NSQIP）中确定接受颅咽管瘤切除术的患者。确定术后 30 天内并发症的发生率。多变量逻辑回归确定与任何并发症和主要（Clavien IV 级）并发症相关的人口统计学、合并症和围手术期特征。
共确定 143 例患者。51 例（35.7%）发生并发症，20 例（14.0%）发生主要并发症，4 例（2.8%）死亡。最常见的并发症为：计划外再入院（13.3%）、机械通气时间延长>48 h（9.8%）和计划外再次手术（9.3%）。多变量分析显示，与任何并发症显著相关的变量为：黑人种族（OR 0.16；95%CI 0.03-0.84；p=0.03）、高血压（OR 5.04；95%CI 1.79-14.17；p=0.002）和手术时间延长（OR 1.27；95%CI 1.01-1.58；p=0.04）。高血压（OR 9.33；95%CI 1.61-54.21；p=0.01）和手术时间延长（OR 1.51；95%CI 1.05-2.17；p=0.03）也是主要并发症的显著预测因素。
三分之一的颅咽管瘤切除术患者术后发生并发症。虽然这一比例较高，但与之前报告的三分之二的比例相比有所降低。手术时间延长和高血压是主要并发症的阳性预测因素。这些信息可以帮助患者咨询和管理决策。我们注意到，其他治疗方法，如内镜手术技术、放射外科和放射治疗，可能具有不同的并发症特征和预测因素。
