Shabo Ehab, Wach Johannes, Hamed Motaz, Güresir Ági, Weinhold Leonie, Vatter Hartmut, Güresir Erdem
Department of Neurosurgery, University Hospital Bonn, Bonn, Germany.
Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, 53127 Bonn, Germany.
Neurosurgery. 2023 Jun 1;92(6):1171-1176. doi: 10.1227/neu.0000000000002340. Epub 2023 Jan 9.
Cerebral venous sinus thrombosis (CVST) is a known complication of posterior fossa surgery near the sigmoid and transverse sinus. The incidence and treatment of postoperative asymptomatic CVST are controversial.
To analyze incidence, risk factors, and management of asymptomatic postoperative CVST after posterior fossa tumor surgery.
In this retrospective, single-center study, we included all patients who underwent posterior fossa tumor surgery in the semisitting position between January 2013 and December 2020. All patients underwent preoperative and postoperative imaging using MRI with/without additional computed tomography angiography. We analyzed the effect of demographic and surgical data on the incidence of postoperative CVST. Furthermore, therapeutic anticoagulation or conservative treatment for postoperative CVST and the incidence of intracranial hemorrhage were investigated.
In total, 266 patients were included. Thirty-three of 266 (12.4%) patients developed postoperative CVST. All patients were asymptomatic. Thirteen of 33 patients received therapeutic anticoagulation, and 20 patients did not. Univariate analysis showed that age ( P = .56), sex ( P = .20), American Society of Anesthesiology status ( P = .13), body mass index ( P = .60), and length of surgery ( P = .176) were not statistically correlated with postoperative CVST. Multivariate analysis revealed that meningioma ( P < .001, odds ratio 11.3, CI 95% 4.1-31.2) and vestibular schwannoma ( P = .013, odds ratio 4.4, CI 95% 1.3-16.3) are risk factors for the development of new postoperative CVST. The use of therapeutic anticoagulation to treat postoperative CVST was associated with a higher rate of intracranial hemorrhage (n = 4, P = .017).
Tumor entity influences the incidence of postoperative CVST. In clinically asymptomatic patients, careful decision making is necessary whether to initiate therapeutic anticoagulation or not.
脑静脉窦血栓形成（CVST）是乙状窦和横窦附近后颅窝手术的一种已知并发症。术后无症状CVST的发生率及治疗存在争议。
分析后颅窝肿瘤手术后无症状CVST的发生率、危险因素及处理方法。
在这项回顾性单中心研究中，我们纳入了2013年1月至2020年12月期间所有采用半坐位进行后颅窝肿瘤手术的患者。所有患者术前和术后均使用磁共振成像（MRI）及/或计算机断层血管造影进行影像学检查。我们分析了人口统计学和手术数据对术后CVST发生率的影响。此外，还研究了术后CVST的治疗性抗凝或保守治疗以及颅内出血的发生率。
共纳入266例患者。266例患者中有33例（12.4%）发生术后CVST。所有患者均无症状。33例患者中有13例接受了治疗性抗凝，20例未接受。单因素分析显示，年龄（P = 0.56）、性别（P = 0.20）、美国麻醉医师协会状态（P = 0.13）、体重指数（P = 0.60）和手术时长（P = 0.176）与术后CVST无统计学相关性。多因素分析显示，脑膜瘤（P < 0.001，比值比11.3，95%可信区间4.1 - 31.2）和前庭神经鞘瘤（P = 0.013，比值比4.4，95%可信区间1.3 - 16.3）是术后新发CVST的危险因素。使用治疗性抗凝治疗术后CVST与较高的颅内出血发生率相关（n = 4，P = 0.017）。
肿瘤类型影响术后CVST的发生率。对于临床无症状患者，决定是否开始治疗性抗凝时需谨慎决策。
