McCormick Justin P, Tilak Ashwini, Lampkin H Brooks, Thompson Harrison M, Miller Peter L, West John M, Cho Do-Yeon, Riley Kristen O, Grayson Jessica W, Woodworth Bradford A
Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
Department of Neurosurgery, University of Alabama at Birmingham; Birmingham, Birmingham, Alabama, U.S.A.
Laryngoscope. 2021 Feb;131(2):E408-E412. doi: 10.1002/lary.28929. Epub 2020 Aug 14.
Spontaneous cerebrospinal fluid (CSF) leaks represent a unique subset of skull base pathology and require distinctive management. Perioperative evaluation and management of intracranial hypertension are essential in preventing further erosion of the skull base and development of recurrent leak. The objective of this study is to evaluate the safety and utility of an expedited protocol for recording and managing intracranial hypertension following endoscopic repair of spontaneous CSF leaks.
Prospectively collected data was reviewed in patients undergoing endoscopic repair of spontaneous CSF leaks between January 2017 and March 2020. A standard intracranial pressure monitoring protocol was compared to an expedited protocol (EP), and data regarding the two groups was compared for leak location, short-term success of skull base repair, complications, hospital length of stay, and cost-based analysis.
Fifty-five patients (standard protocol, n = 28 vs. EP, n = 27) were included in the study. Leak location was similar between cohorts, with the lateral recess being the most common locations in both groups (37.9% vs. 40.6%; P = .90). Postoperative complications (3.6% vs. 7.4%; P = .53) and ventriculoperitoneal shunt rate (32.1% vs. 22.2%; P = .41) were similar among cohorts. There was no difference in lumbar drain complications (0% vs. 7.4%; P = .14) or recurrent leak (7.1% vs. 0%; P = .16). Length of stay was shorter in the EP group [median(interquartile range): 3(1) vs. 2 (1); P < .01]. Total hospital charges were similar between groups (median (USD/$1,000): 83.57 ± 49.58 vs. 83.93 ± 46.11; P = .18).
An expedited monitoring protocol shortened hospital stay without increased risk of complications.
III Laryngoscope, 131:E408-E412, 2021.
自发性脑脊液（CSF）漏是颅底病变的一个独特子集，需要特殊的处理方法。围手术期对颅内高压的评估和管理对于防止颅底进一步侵蚀和复发性漏的发生至关重要。本研究的目的是评估一种快速方案在自发性脑脊液漏内镜修复术后记录和管理颅内高压的安全性和实用性。
回顾性分析2017年1月至2020年3月期间接受自发性脑脊液漏内镜修复术患者的前瞻性收集数据。将标准颅内压监测方案与快速方案（EP）进行比较，并比较两组关于漏口位置、颅底修复短期成功率、并发症、住院时间和基于成本的分析的数据。
本研究纳入了55例患者（标准方案组，n = 28；快速方案组，n = 27）。两组患者的漏口位置相似，侧隐窝是两组中最常见的部位（37.9%对40.6%；P = 0.90）。两组患者术后并发症（3.6%对7.4%；P = 0.53）和脑室腹腔分流率（32.1%对22.2%；P = 0.41）相似。腰大池引流并发症（0%对7.4%；P = 0.14）或复发性漏（7.1%对0%；P = 0.16）无差异。快速方案组的住院时间更短[中位数（四分位间距）：3（1）对2（1）；P < 0.01]。两组的总住院费用相似（中位数（美元/1000美元）：83.57±49.58对83.93±46.11；P = 0.18）。
快速监测方案缩短了住院时间，且未增加并发症风险。
III 喉镜，131:E408 - E412，2021年。
