1Department of Neurology and Neurosurgery, University Medical Center Utrecht.
2Department of Translational Neuroscience, University Medical Center, Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands.
J Neurosurg Pediatr. 2023 Feb 3;31(4):313-320. doi: 10.3171/2022.11.PEDS22421. Print 2023 Apr 1.
The risk of cerebrospinal fluid (CSF) leakage after cranial surgery and its associated complications in children are unclear because of variable definitions and the lack of multicenter studies. In this study, the authors aimed to establish the incidence of CSF leakage after intradural cranial surgery in the pediatric population. In addition, they evaluated potential risk factors and complications related to CSF leakage in the pediatric population.
The authors performed an international multicenter retrospective cohort study in three tertiary neurosurgical referral centers. Included were all patients aged 18 years or younger who had undergone cranial surgery to reach the subdural space during the period between 2015 and 2021. Patients who died or were lost to follow-up within 6 weeks after surgery were excluded. The primary outcome measure was the incidence of CSF leakage, defined as leakage through the skin, within 6 weeks after surgery. Univariable and multivariable logistic regression analyses were performed to identify risk factors for and complications related to CSF leakage.
In total, 759 procedures were identified, performed in 687 individual patients. The incidence of CSF leakage was 7.5% (95% CI 5.7%-9.6%). In the multivariate model, independent risk factors for CSF leakage were hydrocephalus (OR 4.5, 95% CI 2.2-8.9) and craniectomy (OR 7.6, 95% CI 3.0-19.5). Patients with CSF leakage had higher odds of pseudomeningocele (5.7, 95% CI 3.0-10.8), meningitis (21.1, 95% CI 9.5-46.8), and surgical site infection (7.4, 95% CI 2.6-20.8) than patients without leakage.
CSF leakage risk in children after cranial surgery, which is comparable to the risk reported in adults, is an event of major concern and has a serious clinical impact.
由于定义不明确且缺乏多中心研究，儿童开颅术后发生脑脊液（CSF）漏及其相关并发症的风险尚不清楚。本研究旨在确定儿童硬脑膜内颅手术后脑脊液漏的发生率。此外，还评估了与儿童 CSF 漏相关的潜在危险因素和并发症。
作者在三家三级神经外科转诊中心进行了一项国际多中心回顾性队列研究。纳入标准为 2015 年至 2021 年间行开颅术到达硬脑膜下腔的 18 岁以下患者。排除术后 6 周内死亡或失访的患者。主要结局指标为术后 6 周内发生 CSF 漏的发生率，定义为皮肤漏液。采用单变量和多变量逻辑回归分析确定 CSF 漏的危险因素和相关并发症。
共确定了 759 例手术，涉及 687 名患者。CSF 漏的发生率为 7.5%（95%CI，5.7%-9.6%）。多变量模型中，CSF 漏的独立危险因素为脑积水（OR，4.5；95%CI，2.2-8.9）和颅骨切开术（OR，7.6；95%CI，3.0-19.5）。CSF 漏患者发生假性脑膜膨出（OR，5.7；95%CI，3.0-10.8）、脑膜炎（OR，21.1；95%CI，9.5-46.8）和手术部位感染（OR，7.4；95%CI，2.6-20.8）的可能性高于无漏患者。
儿童开颅术后 CSF 漏的风险与成人报告的风险相当，是一个严重的关注事件，具有严重的临床影响。
