Shiferaw Mestet Yibeltal, Baleh Abat Sahlu, Gizaw Abel, Teklemariam Tsegazeab Laeke, Aklilu Abenezer Tirsit, Awedew Atalel Fentahun, Anley Denekew Tenaw, Mekuria Bereket Hailu, Yesuf Ermias Fikiru, Yigzaw Mengistu Ayele, Molla Henok Teshome, Adise Mldie Alemu, Awano Mekides Musie, Teym Abraham
Department of Surgery, Neurosurgery Unit, Debre Tabor University, Debre Tabor, Ethiopia.
Department of Surgery, Neurosurgery Unit, Addis Ababa University, Addis Ababa, Ethiopia.
Neurooncol Pract. 2024 Jul 15;11(6):790-802. doi: 10.1093/nop/npae063. eCollection 2024 Dec.
Ischemic cerebrovascular complications following skull base tumor resections remain a significant factor impacting both short-term and long-term patient outcomes. This study aims to improve risk stratification, surgical decision-making, and postoperative care protocols.
A retrospective cohort study on predictors of ischemic cerebrovascular complications among patients who underwent skull base tumor resection was conducted at 2 high-volume neurosurgical centers in Ethiopia from 2018 to 2023. Binary logistic analysis was performed to see the association of each predictor variable.
The study included 266 patients, with 65.5% being female. The median age and tumor size were 37 (± IQR = 17) years and 4.9 cm (± IQR 1.5), respectively. Ischemic cerebrovascular complications occurred in 19.9% of patients. Middle cranial fossa tumors and tumors spanning both anterior and middle cranial fossa (AOR = 6.75, 95% CI: 1.66-27.54, < .008), grades 3-5 vascular encasement (AOR = 5.04, 95% CI: 1.79-14.12, < .002), near-total resection and gross total resection (AOR = 2.89, 95% CI: 1.01-8.24, < .048), and difficult hemostasis (AOR = 9.37, 95% CI: 3.19-27.52, < .000) were significantly associated with iatrogenic vascular injury. Subarachnoid hemorrhage had a statistically significant association with vasospasm (AOR = 12.27, 95% CI: 1.99-75.37, = .007).
Surgery-related ischemic cerebrovascular complications are common. Thorough perioperative risk stratification and proactive treatment planning are crucial to mitigate vascular insults associated with it. In low-resource settings, neurosurgical services are provided without advanced instruments, leading to more complications. Therefore, it is important to focus on improving neurosurgical setup to enhance patient outcomes.
颅底肿瘤切除术后的缺血性脑血管并发症仍然是影响患者短期和长期预后的重要因素。本研究旨在改进风险分层、手术决策和术后护理方案。
2018年至2023年在埃塞俄比亚的2家大型神经外科中心对接受颅底肿瘤切除术的患者进行了一项关于缺血性脑血管并发症预测因素的回顾性队列研究。进行二元逻辑分析以观察每个预测变量的关联。
该研究纳入了266例患者，其中65.5%为女性。中位年龄和肿瘤大小分别为37（±四分位间距 = 17）岁和4.9 cm（±四分位间距1.5）。19.9%的患者发生了缺血性脑血管并发症。中颅窝肿瘤以及跨越前颅窝和中颅窝的肿瘤（比值比 = 6.75，95%置信区间：1.66 - 27.54，P < 0.008）、3 - 5级血管包绕（比值比 = 5.04，95%置信区间：1.79 - 14.12，P < 0.002）、近全切除和全切除（比值比 = 2.89，95%置信区间：1.01 - 8.24，P < 0.048）以及止血困难（比值比 = 9.37，95%置信区间：3.19 - 27.52，P < 0.000）与医源性血管损伤显著相关。蛛网膜下腔出血与血管痉挛有统计学显著关联（比值比 = 12.27，95%置信区间：1.99 - 75.37，P = 0.007）。
与手术相关的缺血性脑血管并发症很常见。全面的围手术期风险分层和积极的治疗计划对于减轻与之相关的血管损伤至关重要。在资源匮乏地区，在没有先进器械的情况下提供神经外科服务会导致更多并发症。因此，专注于改善神经外科设施以提高患者预后很重要。
