Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
World Neurosurg. 2020 Sep;141:e498-e507. doi: 10.1016/j.wneu.2020.05.227. Epub 2020 May 31.
Larger craniotomy is expected to increase blood flow over a wider range after indirect revascularization. However, the optimal size of craniotomy has not been established. In this study perioperative complications in revascularization surgery for moyamoya disease are evaluated, focusing on craniotomy size.
We retrospectively analyzed 87 hemispheres in 65 patients with moyamoya disease who had undergone revascularization surgery. Areas and types of craniotomy were classified as 1-piece craniotomy in the middle cerebral artery (MCA) territory (1-piece group) in 54 hemispheres (mean area of craniotomy, 40.6 ± 13.5 cm); 2-piece craniotomy in the MCA territory with anterior cerebral artery (ACA) territory (2-piece group) in 16 hemispheres (mean area of craniotomy, 55.4 ± 12.0 cm); and 1-piece craniotomy in both MCA and ACA territories (large group) in 17 hemispheres (mean area of craniotomy, 84.2 ± 11.0 cm). Perioperative complication rates in each craniotomy group were analyzed.
Perioperative complications occurred in 45 hemispheres (52%). Transient, moderate, and severe complications occurred in 38 hemispheres, 3 hemispheres, and 4 hemispheres, respectively. Complication rates in the 1-piece, 2-piece, and large groups were 41%, 63%, and 76%, respectively. Large craniotomy was associated with a significantly higher frequency of complications (P = 0.01). However, no significant difference was found among groups when limiting analysis to moderate and severe complications. Multivariate analysis showed large craniotomy as the only factor independently related to complications (odds ratio, 2.93; 95% confidence interval, 1.08-7.92; P = 0.034).
Large craniotomy is associated with more frequent perioperative complications, especially transient symptoms.
间接血运重建后，预计更大的骨窗可增加更广泛的血流范围。然而，最佳骨窗大小尚未确定。本研究评估了烟雾病血运重建手术围手术期并发症，重点关注骨窗大小。
我们回顾性分析了 65 例烟雾病患者 87 个半脑接受血运重建手术患者的资料。将骨窗分为 MCA 区域 1 块骨窗（1 块组）54 个半脑（骨窗平均面积 40.6 ± 13.5cm）、MCA 和 ACA 区域 2 块骨窗（2 块组）16 个半脑（骨窗平均面积 55.4 ± 12.0cm）和 MCA 和 ACA 区域各 1 块骨窗（大骨窗组）17 个半脑（骨窗平均面积 84.2 ± 11.0cm）。分析每组骨窗的围手术期并发症发生率。
45 个半脑（52%）发生围手术期并发症。38 个半脑发生短暂性、中度和重度并发症，3 个半脑和 4 个半脑分别发生中度和重度并发症。1 块、2 块和大骨窗组的并发症发生率分别为 41%、63%和 76%。大骨窗与并发症发生率显著升高相关（P = 0.01）。然而，当将中度和重度并发症的分析限制在特定组时，各组之间没有发现显著差异。多变量分析显示大骨窗是唯一与并发症相关的独立因素（比值比，2.93；95%置信区间，1.08-7.92；P = 0.034）。
大骨窗与更频繁的围手术期并发症相关，尤其是短暂性症状。
