Swedish Neuroscience Institute, Seattle, WA.
Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
Spine (Phila Pa 1976). 2020 Jan 15;45(2):109-115. doi: 10.1097/BRS.0000000000003184.
. Retrospective study.
. To determine incidence, risk factors, complications, and early postoperative outcome in patients with intraoperative ischemic stroke during elective spine surgery.
. Overall, stroke is the fifth leading cause of death in the United States and the second leading cause of death worldwide. It can be a catastrophic event and the main cause of neurological disability in adults.
. A retrospective review of the electronic medical records of patients who underwent elective spine surgery between January 2016 and November 2018 at a larger tertiary referral center was conducted. Patients with infection and neoplastic disease were excluded. Patient demographics, pre- and postoperative neurological status, surgical treatment, surgical time, blood loss, intraoperative abnormalities, risk factors, history of stroke, medical treatment, diagnostics, hospital stay, complications, and mortality were collected.
. Out of 5029 surgically treated patients receiving elective spine surgery, a total of seven patients (0.15%) were identified who developed an ischemic stroke during the surgical procedure. Patients were predominantly females (n = 6). Ischemic pontine stroke occurred in two patients. Further distributions of ischemic stroke were: left caudate nucleus, left posterior inferior cerebellar artery, left external capsule, left middle cerebral artery, and acute ischemic supratentorial spots. The main risk factors identified for intraoperative ischemic stroke include hypertension, diabetes, smoking, dyslipidemia, and possibly major intraoperative CSF leak. Three patients (43%) had neurological deficits which did not improve during hospital stay. Two patients recovered fully and two patients died. Therefore, in-hospital mortality rate of this subset of patients was 29%.
. With the increase of spinal procedures, it is important to identify patients at risk for having an ischemic stroke and to optimize their comorbidities preoperatively. Patients with intraoperative ischemic stroke carry a higher risk for morbidity and mortality during the index hospitalization.
回顾性研究。
确定择期脊柱手术中发生术中缺血性卒中的患者的发生率、危险因素、并发症和术后早期结果。
总的来说，卒中是美国第五大死亡原因，也是全球第二大死亡原因。它可能是灾难性事件，也是成年人神经功能障碍的主要原因。
对 2016 年 1 月至 2018 年 11 月在一家大型三级转诊中心接受择期脊柱手术的患者的电子病历进行回顾性审查。排除感染和肿瘤性疾病的患者。收集患者的人口统计学资料、术前和术后神经状态、手术治疗、手术时间、失血量、术中异常、危险因素、卒中病史、药物治疗、诊断、住院时间、并发症和死亡率。
在接受择期脊柱手术治疗的 5029 例患者中，共有 7 例（0.15%）患者在手术过程中发生缺血性卒中。患者主要为女性（n=6）。发生缺血性桥脑卒中 2 例。进一步分布的缺血性卒中为：左尾状核、左小脑后下动脉、左外囊、左大脑中动脉和急性缺血性幕上斑点。术中缺血性卒中的主要危险因素包括高血压、糖尿病、吸烟、血脂异常，可能还有术中大量脑脊液漏。3 例（43%）患者存在神经功能缺损，在住院期间未改善。2 例患者完全恢复，2 例患者死亡。因此，这组患者的住院死亡率为 29%。
随着脊柱手术数量的增加，识别有发生缺血性卒中风险的患者并在术前优化其合并症非常重要。术中发生缺血性卒中的患者在指数住院期间的发病率和死亡率更高。
4。
