Department of Neurological Surgery, University of Alabama at Birmingham, 1057 Faculty Office Tower, 510 20th Street South, Birmingham, AL, 35294-3410, USA.
Department of Neurological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Neurosurg Rev. 2021 Apr;44(2):1093-1101. doi: 10.1007/s10143-020-01296-1. Epub 2020 Apr 18.
Retrosigmoid craniotomy for microvascular decompression (MVD) has been traditionally performed via craniectomy. Various closure techniques have been described, yet factors associated with wound-related complications remain undetermined. Accordingly, herein, we sought to identify risk factors associated with wound-related complications after such procedures. An institutional retrospective case-control study was performed; outcomes of interest were cerebrospinal fluid (CSF) leak, wound dehiscence, wound infection, and pseudomeningocele. Univariate analysis was performed using Wilcoxon rank sum test for non-parametric continuous outcomes and chi-square test for categorical outcomes. Multivariate logistic regression was performed on binomial outcome variables. The study population included 197 patients who underwent MVD for trigeminal neuralgia (83.2%), hemifacial spasm (12.2%), vestibular nerve section (3.0%), and glossopharyngeal neuralgia (1.5%). The overall wound-related complication rate was 14.2% (n = 28), including twelve patients (6.1%) with CSF leak, ten patients (5.1%) with wound infection, ten patients (5.1%) with pseudomeningocele, and nine (4.6%) patients with wound dehiscence. Using multivariate logistic regression, preoperative anemia and current tobacco use were associated with significantly higher rates of complications (OR 6.01 and 4.58, respectively; p < 0.05), including CSF leak (OR 12.83 and 12.40, respectively, p < 0.05). Of note, use of synthetic bone substitute for cranioplasty was associated with a significantly lower rate of complications (OR 0.13, p < 0.01). Preoperative anemia and current tobacco use significantly increased, while synthetic bone substitute cranioplasty significantly decreased, odds of wound-related complications, the need for treatment, and CSF leaks. Additionally, higher BMI, longer operative duration, and prior radiosurgery may increase risk for wound-related complications.
经枕下乙状窦后入路行微血管减压术（MVD）治疗一直以来都需要开颅。目前已经描述了各种闭合技术，但与伤口相关并发症相关的因素仍未确定。因此，本研究旨在确定与术后伤口相关并发症相关的危险因素。这是一项机构回顾性病例对照研究；感兴趣的结果是脑脊液（CSF）漏、伤口裂开、伤口感染和假性脑膜膨出。非参数连续变量采用 Wilcoxon 秩和检验，分类变量采用卡方检验进行单变量分析。二项分类变量采用多变量逻辑回归分析。研究人群包括 197 例行 MVD 治疗三叉神经痛（83.2%）、面肌痉挛（12.2%）、前庭神经切断术（3.0%）和舌咽神经痛（1.5%）的患者。总的伤口相关并发症发生率为 14.2%（n=28），包括 12 例（6.1%）CSF 漏、10 例（5.1%）伤口感染、10 例（5.1%）假性脑膜膨出和 9 例（4.6%）伤口裂开。多变量逻辑回归分析显示，术前贫血和当前吸烟与并发症发生率显著相关（OR 分别为 6.01 和 4.58，p<0.05），包括 CSF 漏（OR 分别为 12.83 和 12.40，p<0.05）。值得注意的是，使用合成骨替代物行颅骨成形术与并发症发生率显著降低相关（OR 0.13，p<0.01）。术前贫血和当前吸烟显著增加，而合成骨替代物颅骨成形术显著降低与伤口相关并发症、治疗和 CSF 漏的发生几率相关。此外，较高的 BMI、较长的手术时间和既往放射外科手术可能会增加伤口相关并发症的风险。
