Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
Acta Neurochir (Wien). 2020 May;162(5):1095-1099. doi: 10.1007/s00701-020-04288-8. Epub 2020 Mar 19.
Postoperative head CT imaging is routinely performed for detection of postoperative complications following intracranial procedures. However, it remains unclear whether with regard to radiation exposure, costs, and possibly lack of consequences this practice is truly justified in various operative procedures. The objective of this study was to analyze whether routine postoperative CT imaging after microvascular decompression (MVD) is necessary or whether it may be abandoned.
A series of 202 MVD surgeries for trigeminal neuralgia (179), hemifacial spasm (17), vagoglossopharyngeal neuralgia (2), paroxysmal vertigo (2), and pulsatile tinnitus (2) operated by the senior surgeon (JKK) and who had postoperative routine CT imaging was analyzed.
Routine postoperative CT imaging detected small circumscribed postoperative hemorrhage in 9/202 (4.4%) instances. Hemorrhage was localized at the site of the Teflon felt (1/9), the cerebellum (4/9), in the frontal subdural space (3/9), and in the frontal subarachnoid space (1/9). In two patients, asymptomatic hemorrhage was accompanied by mild cerebellar edema (1%), and another patient had mild transient hydrocephalus (0.5%). Furthermore, there were small accumulations of intracranial air in 86/202 instances. No other complications such as infarction or skull fracture secondary to fixation with the Mayfield clamp were detected. MVD had been performed for trigeminal neuralgia in 6/9 patients, for hemifacial spasm in 2/9, and in one patient with both. No patient underwent a second surgery. Hemorrhage was symptomatic at the time of imaging in only one instance who had mild postoperative gait ataxia. Two patients with hemorrhage developed delayed facial palsy most likely unrelated to hemorrhage which remitted with corticosteroid treatment. At 3-month follow-up and at long-term follow-up, they had no neurological deficits.
Routine postoperative CT imaging is not necessary after MVD in a standard setting in patients who do not have postoperative neurological deficits.
颅内手术后常规行头部 CT 成像以检测术后并发症。然而，对于这种做法是否真正合理，还不清楚，尤其是在各种手术中，需要考虑辐射暴露、成本，以及可能缺乏后果等方面。本研究旨在分析微血管减压术（MVD）后常规行术后 CT 成像是否有必要，或者是否可以放弃。
对 202 例行 MVD 手术的患者进行分析，这些患者均由资深外科医生（JKK）主刀，术后常规行 CT 成像。手术适应证为三叉神经痛（179 例）、面肌痉挛（17 例）、舌咽神经痛（2 例）、阵发性眩晕（2 例）和搏动性耳鸣（2 例）。
常规术后 CT 成像发现 9/202 例（4.4%）患者存在局限性小范围术后出血。出血位于特氟隆毡（1/9）、小脑（4/9）、额部硬脑膜下腔（3/9）和额部蛛网膜下腔（1/9）。在 2 例患者中，无症状性出血伴有轻度小脑水肿（1%），另 1 例患者伴有轻度短暂性脑积水（0.5%）。此外，86/202 例患者存在少量颅内积气。未发现其他并发症，如固定用 Mayfield 夹引起的梗死或颅骨骨折。9 例患者中，6 例因三叉神经痛行 MVD，2 例因面肌痉挛行 MVD，1 例同时因三叉神经痛和面肌痉挛行 MVD。无患者行二次手术。仅 1 例出血患者在影像检查时出现轻度术后步态共济失调。2 例出血患者出现迟发性面瘫，极有可能与出血无关，经皮质类固醇治疗后缓解。在 3 个月和长期随访时，他们均无神经功能缺损。
在标准情况下，对于无术后神经功能缺损的 MVD 患者，术后常规行 CT 成像并非必需。
