Zhang Chengda, Ge Lingli, Li Zhengwei, Zhang Tingbao, Chen Jincao
Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
Department of Neurosurgery, The Affiliated Hospital of Hubei University of Medicine, The First People's Hospital of Xiangyang, Xiangyang, China.
Front Surg. 2022 Jun 16;9:886472. doi: 10.3389/fsurg.2022.886472. eCollection 2022.
There is no general consensus on the placement of preoperative and intraoperative external ventricular drainage (EVD) in patients with lateral ventricular tumors (LVTs). The aim of this study was to identify the predictors of postoperative acute and persistent hydrocephalus need for postoperative cerebrospinal fluid (CSF) drainage and guide the management of postoperative EVD in patients with LVTs.
We performed a single-institution, retrospective analysis of patients who underwent resection of LVTs in our Department between January 2011 and March 2021. Patients were divided between one group that required CSF drainage and another group without the need for CSF drainage. We analyzed the two groups by univariate and multivariate analyses to identify the predictors of the requirement for postoperative CSF drainage due to symptomatic intracranial hypertension caused by hydrocephalus.
A total of 97 patients met the inclusion criteria, of which 31 patients received preoperative or intraoperative EVD. Ten patients without prophylactic EVD received postoperative EVD for postoperative acute hydrocephalus. Eleven patients received postoperative ventriculoperitoneal(VP) shunt subsequently. Logistic regression analysis showed that tumor invasion of the anterior ventricle (OR = 7.66), transependymal edema (OR = 8.76), and a large volume of postoperative intraventricular hemorrhage (IVH) (OR = 6.51) were independent risk factors for postoperative acute hydrocephalus. Perilesional edema (OR = 33.95) was an independent risk factor for postoperative VP shunt due to persistent hydrocephalus.
Postoperative hydrocephalus is a common complication in patients with LVTs. These findings might help to determine whether to conduct earlier interventions.
对于侧脑室肿瘤（LVT）患者术前及术中脑室外引流（EVD）的放置，目前尚无普遍共识。本研究的目的是确定术后急性和持续性脑积水的预测因素、术后脑脊液（CSF）引流的必要性，并指导LVT患者术后EVD的管理。
我们对2011年1月至2021年3月在我院接受LVT切除术的患者进行了单中心回顾性分析。患者分为需要CSF引流的一组和不需要CSF引流的另一组。我们通过单因素和多因素分析对两组进行分析，以确定因脑积水引起的症状性颅内高压导致术后CSF引流需求的预测因素。
共有97例患者符合纳入标准，其中31例患者接受了术前或术中EVD。10例未进行预防性EVD的患者因术后急性脑积水接受了术后EVD。11例患者随后接受了术后脑室腹腔（VP）分流术。Logistic回归分析显示，肿瘤侵犯前脑室（OR = 7.66）、经室管膜水肿（OR = 8.76）和大量术后脑室内出血（IVH）（OR = 6.51）是术后急性脑积水的独立危险因素。病灶周围水肿（OR = 33.95）是因持续性脑积水导致术后VP分流的独立危险因素。
术后脑积水是LVT患者的常见并发症。这些发现可能有助于确定是否进行早期干预。
