Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
Oper Neurosurg (Hagerstown). 2023 Mar 1;24(3):262-267. doi: 10.1227/ons.0000000000000503. Epub 2022 Dec 9.
Microvascular decompression (MVD) using a retrosigmoid approach is a highly effective, open-surgical procedure for neurovascular conflict in the posterior fossa, although there is a risk of postoperative cerebrospinal fluid (CSF) leak.
To identify factors associated with postoperative CSF leakage after MVD.
We retrospectively reviewed all patients who underwent MVDs at our institution from 2007 to 2020. Patient demographics, clinical diagnoses, and procedural characteristics were recorded and compared. Factors leading to CSF leak were analyzed using χ 2 , univariate, and multivariate regression.
Of 1011 patients who underwent MVDs, 37 (3.7%) presented with postoperative CSF leaks. In univariate analysis, the use of Cranios/Norian to obliterate the air cells was protective against CSF leak ( P = .01). Craniotomies ( P = .002), the use of dural substitutes such as Durepair ( P = .04), dural onlays such as DuraGen ( P = .04), muscle/fascia ( P = .03), and titanium mesh cranioplasty >5 cm ( P = .03) were associated with CSF leak. On multivariate analysis, only the presence of craniotomies ( P = .04) and nonprimary dural closure ( P = .03) were significant risk factors for CSF leak. When excluding the 34 (3.4%) patients who underwent a craniotomy, the lack of primary dural closure still remained significantly associated with postoperative CSF leak ( P = .04).
Our results represent one of the largest series of posterior fossa surgeries for a uniform indication in North America. Our study demonstrates increased risk for postoperative CSF leak when craniotomies are performed and when primary dural closure is not established. Given the small sample of patients who received a craniotomy, however, future studies corroborating this finding should be performed.
经颅后窝入路微血管减压术（MVD）是治疗后颅窝神经血管冲突的一种高效、开放式手术，但存在术后脑脊液（CSF）漏的风险。
确定 MVD 术后 CSF 漏的相关因素。
我们回顾性分析了 2007 年至 2020 年在我院行 MVD 的所有患者。记录患者的人口统计学、临床诊断和手术特征，并进行比较。采用 χ 2 、单因素和多因素回归分析导致 CSF 漏的因素。
在 1011 例行 MVD 的患者中，37 例（3.7%）术后出现 CSF 漏。单因素分析显示，使用 Cranios/Norian 填充气房可预防 CSF 漏（P=.01）。开颅术（P=.002）、使用 Durepair 等硬脑膜替代物（P=.04）、DuraGen 等硬脑膜覆盖物（P=.04）、肌肉/筋膜（P=.03）和大于 5 cm 的钛网颅骨成形术（P=.03）与 CSF 漏相关。多因素分析显示，仅开颅术（P=.04）和非原发性硬脑膜关闭（P=.03）是 CSF 漏的显著危险因素。排除 34 例（3.4%）行开颅术的患者后，原发性硬脑膜关闭仍然与术后 CSF 漏显著相关（P=.04）。
我们的结果代表了北美一项统一适应证的后颅窝手术中最大的系列之一。我们的研究表明，开颅术和未建立原发性硬脑膜关闭时，术后 CSF 漏的风险增加。然而，鉴于接受开颅术的患者样本量较小，应进行进一步的研究来证实这一发现。
