术后脑池或脑室内积气预示脑转移瘤早期软脑膜疾病：一项回顾性研究

Postoperative Air in the Cisterns or Ventricles Predicts Early Leptomeningeal Disease of Brain Metastases: A Retrospective Study.

作者信息

Ikeuchi Yusuke, Nishihara Masamitsu, Hosoda Kohkichi, Ashida Noriaki, Yamanishi Shunsuke, Nagashima Hiroaki, Tanaka Kazuhiro, Muragaki Yoshihiro, Sasayama Takashi

机构信息

Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Neurosurgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan.

Department of Neurosurgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan.

出版信息

World Neurosurg. 2025 Jan;193:903-910. doi: 10.1016/j.wneu.2024.10.118. Epub 2024 Nov 24.

DOI:10.1016/j.wneu.2024.10.118

PMID:39521402

Abstract

OBJECTIVE

We investigated whether air in the cisterns or ventricles on postoperative computed tomography (CT) (reflecting the opening of the cerebrospinal fluid spaces during surgery) is a predictor of classical or nodular leptomeningeal disease (LMD) after resection of brain metastases.

METHODS

We retrospectively analyzed 73 patients who underwent gross total resection of brain metastases between 2012 and 2020. Patients with air in the cisterns or ventricles on postoperative day 1 CT were categorized into the air-positive group, whereas those without air in the cisterns or ventricles on postoperative day 1 CT were categorized into the air-negative group. The primary outcome was the occurrence of classical or nodular LMD (nLMD), which was assessed using survival analysis.

RESULTS

There were 15 (21%) patients in the air-positive group and 58 (79%) in the air-negative group. The air-positive group exhibited significantly more cerebellar and ventricular contact lesions than the air-negative group. The 4-year rate of classical or nLMD was significantly higher in the air-positive group than in the air-negative group (67% vs. 33%, P < 0.001). Multivariate analysis identified air in the cisterns or ventricles on postoperative CT as the only significant predictor of classical or nLMD (P < 0.001).

CONCLUSIONS

Postoperative air in the cisterns or ventricles can predict early classical or nodular leptomeningeal disease.

摘要

目的

我们研究了术后计算机断层扫描（CT）显示的脑池或脑室内气体（反映手术期间脑脊液间隙的开放情况）是否为脑转移瘤切除术后典型或结节性软脑膜疾病（LMD）的预测指标。

方法

我们回顾性分析了2012年至2020年间接受脑转移瘤全切除的73例患者。术后第1天CT显示脑池或脑室内有气体的患者被归入气体阳性组，而术后第1天CT显示脑池或脑室内无气体的患者被归入气体阴性组。主要结局是典型或结节性LMD的发生情况，采用生存分析进行评估。

结果

气体阳性组有15例（21%）患者，气体阴性组有58例（79%）患者。气体阳性组小脑和脑室接触性病变明显多于气体阴性组。气体阳性组的4年典型或结节性LMD发生率显著高于气体阴性组（67%对33%，P<0.001）。多因素分析确定术后CT显示的脑池或脑室内气体是典型或结节性LMD的唯一显著预测指标（P<0.001）。