Department of Neurosurgery, Brain Center, University Medical Centre Utrecht, Utrecht, the Netherlands.
Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Neurosurgery. 2023 Jun 1;92(6):1177-1182. doi: 10.1227/neu.0000000000002345. Epub 2023 Jan 23.
Incisional cerebrospinal fluid (iCSF) leakage is a serious complication after intradural cranial surgery.
To determine the incidence and risk factors of iCSF leakage after craniotomy. Secondarily, the complications after iCSF leakage and the success rate of iCSF leakage treatment was studied.
All patients who underwent an intradural cranial surgery from 2017 to 2018 at 5 neurosurgical centers were retrospectively included. Data were retrieved from medical records with 2 months of follow-up. First, univariate regression analyses were performed. Subsequently, identified risk factors were evaluated in a multivariate regression analysis.
In total 2310 consecutive patients were included. Total iCSF leakage rate was 7.1% (n = 165). Younger age, male, higher body mass index, smoking, infratentorial surgery, and use of a dural substitute were associated with increased iCSF leakage risk, and use of a sealant reduced that risk. The odds for developing a wound infection and/or meningitis were 15 times higher in patients with iCSF leakage compared with patients without leakage. Initial conservative iCSF leakage treatment failed in 48% of patients. In 80% of cases, external cerebrospinal fluid drainage ceased the iCSF leakage. A total of 32% of patients with iCSF leakage required wound revision surgery.
iCSF leakage risk increases by younger age, higher body mass index, smoking, infratentorial craniotomy, and dural substitute use, whereas sealant use reduced the risk for iCSF leakage. The leak increases the risk of postoperative infections. When iCSF leakage occurs, immediate external cerebrospinal fluid drainage or wound revision should be considered.
切口脑脊液（iCSF）漏是硬脊膜内颅脑手术后的一种严重并发症。
确定开颅术后 iCSF 漏的发生率和危险因素。其次，研究 iCSF 漏的并发症和 iCSF 漏治疗的成功率。
回顾性纳入 2017 年至 2018 年在 5 个神经外科中心接受硬脊膜内颅脑手术的所有患者。从病历中检索数据并随访 2 个月。首先进行单变量回归分析。随后，对确定的危险因素进行多变量回归分析。
共纳入 2310 例连续患者。总 iCSF 漏发生率为 7.1%（n=165）。年龄较小、男性、较高的体重指数、吸烟、幕下手术和使用硬脑膜替代物与 iCSF 漏风险增加相关，而使用密封剂则降低了该风险。与无 iCSF 漏的患者相比，发生伤口感染和/或脑膜炎的几率高 15 倍。初始保守 iCSF 漏治疗在 48%的患者中失败。在 80%的情况下，外部脑脊液引流停止了 iCSF 漏。共有 32%的 iCSF 漏患者需要进行伤口修复手术。
年龄较小、体重指数较高、吸烟、幕下开颅术和硬脑膜替代物的使用会增加 iCSF 漏的风险，而密封剂的使用则降低了 iCSF 漏的风险。漏液会增加术后感染的风险。发生 iCSF 漏时，应立即考虑外部脑脊液引流或伤口修复。
