Birkenbeuel Jack L, Abiri Arash, Warner Danielle C, Nguyen Emily, Marquina Sylvana, Gowda Sanjita, Hsu Frank P K, Kuan Edward C
Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, 101 The City Drive South, Orange, CA 92868, USA.
J Clin Neurosci. 2022 Jul;101:1-8. doi: 10.1016/j.jocn.2022.04.026. Epub 2022 Apr 28.
The purpose of this study is to describe the morbidity in patients undergoing endoscopic skull base surgery (ESBS) with and without intra-operative lumbar drain (LD) placement. A retrospective review of all patients undergoing ESBS from July 2018 to August 2020 at a tertiary academic skull base surgery program was conducted. Those with LD placement for aiding in suprasellar dissection and/or for CSF diversion following skull base repair were included. LD-related medical and technical complications were combined as composite outcomes to assess overall event rates in those with and without LD. 104 patients were included. Of the 104 participants, 64 (61.5%) had LD placed. Of these 64, 1 (0.96%) and 2 (1.9%) experienced postoperative medical (hypophysitis) and related technical (2 blood patches) complications, respectively. There was one case of postoperative CSF leak (in LD group) and no cases of DVT/PE or meningitis. LD use was not associated with increased risk of any complication (p = 0.165) compared to those without LD. There were no significant differences in rates of postoperative epistaxis (p = 0.427), readmission (p = 0.629), or reoperation (p = 0.165) between groups. Female sex was the only predictor of increased overall complication rates in patients with LD (OR, 1.122, 95% CI, 1.010-1.247, p = 0.032). Our findings suggest judicious use of a LD in endoscopic skull base surgery within a reasonable time does not increase the incidence of overall medical or technical complications, readmission, and reoperation.
本研究的目的是描述接受内镜颅底手术（ESBS）时放置或未放置术中腰大池引流（LD）患者的发病率。对2018年7月至2020年8月在某三级学术颅底手术项目中接受ESBS的所有患者进行了回顾性研究。纳入那些放置LD以辅助鞍上解剖和/或颅底修复后进行脑脊液引流的患者。将与LD相关的医学和技术并发症合并为综合结果，以评估放置和未放置LD患者的总体事件发生率。共纳入104例患者。在这104名参与者中，64例（61.5%）放置了LD。在这64例患者中，分别有1例（0.96%）和2例（1.9%）出现术后医学并发症（垂体炎）和相关技术并发症（2次血凝块填充）。有1例术后脑脊液漏（在LD组），没有深静脉血栓形成/肺栓塞或脑膜炎病例。与未放置LD的患者相比，使用LD与任何并发症风险增加无关（p = 0.165）。两组之间术后鼻出血发生率（p = 0.427）、再入院率（p = 0.629）或再次手术率（p = 0.165）无显著差异。女性是放置LD患者总体并发症发生率增加的唯一预测因素（OR，1.122，95%CI，1.010 - 1.247，p = 0.032）。我们的研究结果表明，在内镜颅底手术中在合理时间内明智地使用LD不会增加总体医学或技术并发症、再入院和再次手术的发生率。
