Yamaguchi Rei, Tosaka Masahiko, Mukada Naoto, Tsuneoka Haruka, Shimauchi-Otaki Hiroya, Miyagishima Takaaki, Honda Fumiaki, Yoshimoto Yuhei
Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
J Neurol Surg B Skull Base. 2022 Sep 14;84(6):578-584. doi: 10.1055/a-1924-9736. eCollection 2023 Dec.
Postoperative cerebrospinal fluid (CSF) leakage in endoscopic transsphenoidal surgery is a potential risk that requires immediate repair. We investigated the potential of common postoperative hematological examinations for diagnosing postoperative CSF leakage. We retrospectively studied 214 consecutive cases who underwent endoscopic transsphenoidal approach (ETSA; transsellar approach) or extended ETSA (E-ETSA). Patients with postoperative CSF leakage were defined the leak group (group L), and patients without were defined as the nonleak group (group N). Postoperative C-reactive protein (CRP) was compared between the ETSA and E-ETSA groups, and between the N and L groups. The values of white blood cell count and CRP 1 to 7 days after surgery were significantly higher in the L group. Especially, CRP was clearly elevated in the L group ( < 0.001). The CRP value was higher in patients in the N group after E-ETSA than after ETSA ( < 0.001). CRP increased on the day after surgery but decreased gradually thereafter in patients after ETSA and in the N group. In contrast, CRP value tended to increase gradually after surgery in the L group. In particular, the CRP on the day before the CSF leak was confirmed was clearly higher than on the fifth to seventh days in the N group. Elevated CRP after endoscopic endonasal transsphenoidal surgery is a potential marker of CSF leakage.
内镜经蝶窦手术术后脑脊液漏是一种需要立即修复的潜在风险。我们研究了常见术后血液学检查对诊断术后脑脊液漏的潜力。
我们回顾性研究了214例连续接受内镜经蝶窦入路（ETSA；经鞍入路）或扩大ETSA（E-ETSA）的患者。术后发生脑脊液漏的患者定义为漏液组（L组），未发生脑脊液漏的患者定义为非漏液组（N组）。比较ETSA组和E-ETSA组之间以及N组和L组之间术后C反应蛋白（CRP）的情况。
L组术后1至7天的白细胞计数和CRP值显著更高。尤其是，L组的CRP明显升高（<0.001）。E-ETSA术后N组患者的CRP值高于ETSA术后（<0.001）。ETSA术后患者及N组患者术后第1天CRP升高，但此后逐渐下降。相比之下，L组术后CRP值倾向于逐渐升高。特别是，在确认脑脊液漏前一天的CRP明显高于N组术后第5至7天。
内镜鼻内经蝶窦手术后CRP升高是脑脊液漏的一个潜在标志物。
