Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.
Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.
Acta Neurochir (Wien). 2024 Jul 24;166(1):305. doi: 10.1007/s00701-024-06207-7.
Craniotomies for tumor resection can at times result in wound complications which can be devastating in the treatment of neuro-oncological patients. A cranial stair-step technique was recently introduced as an approach to mitigate these complications, especially in this patient population who often exhibit additional risk factors including steroids, chemoradiation, and VEGF inhibitor treatments. This study evaluates our cranial stair-step approach by comparing its postoperative complications using propensity score matching with those of a standard craniotomy wound closure.
A retrospective chart review was conducted on patients with intracranial neoplasms undergoing primary craniotomy at a single institution. Patients with prior craniotomies and less than three months of follow-up were excluded. Analyses were performed using R Studio.
383 patients were included in the study, 139 of whom underwent the stair-step technique while the rest underwent traditional craniotomy closures. The stair-step cohort was older, had higher ASA classes, and had a higher prevalence of coronary artery disease. The stair-step patients were administered fewer steroids before (40.29% vs. 56.56%, p < 0.01) and after surgery (87.05% vs. 94.26%, p = 0.02), fewer immunotherapy (12.95% vs. 20.90%, p = 0.05), but they received more radiation preoperatively (15.11% vs. 8.61%, p = 0.05). They also underwent fewer operations for recurrences and residuals (0.72% vs. 10.66%, p = 0.01). On propensity score matching, we found 111 matched pairs with no differences except follow-up duration (p < 0.01). The stair-step group had fewer soft tissue infections (0% vs. 3.60%, p = 0.04), fewer total wound complications (0% vs. 4.50%, p = 0.02), was operated on less for these complications (0% vs. 3.60%, p = 0.04), and had a shorter length of stay (6 vs. 9 days, p < 0.01). Notably, the average time to wound complication in our cohort was 44 days, well within our exclusion criteria and follow-up duration.
The cranial stair-step technique is safe and effective in reducing rates of wound complications and reoperation for neuro-oncologic patients requiring craniotomy.
肿瘤切除术有时会导致颅脑切开术的并发症，这对于神经肿瘤患者的治疗可能是毁灭性的。最近引入了一种颅梯技术作为减轻这些并发症的方法，尤其是对于那些经常存在额外风险因素的患者，包括类固醇、放化疗和 VEGF 抑制剂治疗。本研究通过与标准颅骨切开术伤口闭合的倾向性评分匹配来评估我们的颅梯方法。
对一家机构接受原发性开颅术的颅内肿瘤患者进行了回顾性图表审查。排除了有先前开颅术和随访时间少于三个月的患者。使用 R Studio 进行分析。
共纳入 383 例患者，其中 139 例行梯级技术，其余行传统开颅术闭合。梯级组年龄较大，ASA 分级较高，冠心病患病率较高。梯级组患者术前（40.29% vs. 56.56%，p<0.01）和术后（87.05% vs. 94.26%，p=0.02）使用类固醇的次数较少，免疫治疗（12.95% vs. 20.90%，p=0.05）较少，但术前接受放疗的次数较多（15.11% vs. 8.61%，p=0.05）。他们还进行了较少的复发性和残余性手术（0.72% vs. 10.66%，p=0.01）。在倾向评分匹配后，我们发现了 111 对匹配对，除了随访时间外（p<0.01），没有其他差异。梯级组软组织感染发生率较低（0% vs. 3.60%，p=0.04），总伤口并发症发生率较低（0% vs. 4.50%，p=0.02），为这些并发症进行手术的次数较少（0% vs. 3.60%，p=0.04），住院时间较短（6 天 vs. 9 天，p<0.01）。值得注意的是，我们队列中伤口并发症的平均时间为 44 天，远在我们的排除标准和随访时间内。
对于需要开颅术的神经肿瘤患者，颅梯技术在降低伤口并发症和再次手术的发生率方面是安全有效的。
