后颅窝脑转移瘤切除术后的短暂性和永久性脑积水：发生率、危险因素及围手术期放置外引流的必要性
Transient and permanent hydrocephalus following resection of brain metastases located in the posterior fossa: incidence, risk factors and the necessity of perioperative external ventricular drainage placement.
作者信息
Shabo Ehab, Potthoff Anna-Laura, Zeyen Thomas, Layer Julian P, Ehrentraut Stefan, Scorzin Jasmin, Lehmann Felix, Lehnen Nils Christian, Banat Mohammed, Weller Johannes, Gessler Florian, Paech Daniel, Hamed Motaz, Borger Valeri, Radbruch Alexander, Herrlinger Ulrich, Weinhold Leonie, Vatter Hartmut, Schneider Matthias
机构信息
Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Department of Neurooncology, Center of Neurology, University Hospital Bonn, Bonn, Germany.
出版信息
J Neurooncol. 2025 Feb;171(3):681-689. doi: 10.1007/s11060-024-04890-1. Epub 2024 Nov 28.
PURPOSE
Prophylactic insertion of an external ventricular drainage (EVD) prior to the resection of posterior fossa metastases (PFMs) is a common approach to address postoperative transient and permanent hydrocephalus. However, predicting surgery-related hydrocephalus in the preoperative phase continues to be a challenge. This study aims to analyze the incidence, preoperatively collectable risk factors and necessity of perioperative external ventricular drainage placement after posterior fossa metastasis surgery.
METHODS
All patients undergoing surgery for PFMs at the authors' neuro-oncological center between 2015 and 2021 were identified and assessed for postoperative hydrocephalus occurrence. Tumour volume, edema volume, and 4th ventricle volume were assessed on preoperative magnetic resonance imaging scans using the IntelliSpace Portal 5.0. A multivariable logistic regression analysis was performed to identify possible predictors for postoperative hydrocephalus occurrence.
RESULTS
Postoperative hydrocephalus occurred in 14 of the 130 identified PFM patients (11%). Multivariable analysis and receiver operating characteristic (ROC) analysis revealed a 4th -ventricle-to-tumor-volume ratio ≤ 0.02 (OR 33.1, 95% CI 3.8-284.3, p = 0.001), an edema-to- tumor-volume ratio ≤ 0.85 (OR 10.6, 95% CI 2.4-47.4, p = 0.002), an imaging-morphological contact to the 4th ventricle (OR 5, 95% CI 1.4-18, p = 0.013), and multiple intracranial metastases (OR 2.4, 95% CI 1-5.9, p = 0.045) as independent predictors for surgery-related postoperative hydrocephalus occurrence.
CONCLUSION
The present study identifies preoperatively detectable risk factors for the occurrence of postoperative hydrocephalus following surgery for PFMs. These findings may provide guidance in clinical decision-making regarding prophylactic EVD placement.
目的
在切除后颅窝转移瘤（PFMs）之前预防性插入外部脑室引流（EVD）是解决术后短暂性和永久性脑积水的常用方法。然而，在术前阶段预测手术相关的脑积水仍然是一项挑战。本研究旨在分析后颅窝转移瘤手术后围手术期外部脑室引流放置的发生率、术前可收集的危险因素及必要性。
方法
确定并评估2015年至2021年期间在作者所在神经肿瘤中心接受PFMs手术的所有患者术后脑积水的发生情况。使用IntelliSpace Portal 5.0在术前磁共振成像扫描上评估肿瘤体积、水肿体积和第四脑室体积。进行多变量逻辑回归分析以确定术后脑积水发生的可能预测因素。
结果
在130例确诊的PFM患者中，14例（11%）发生了术后脑积水。多变量分析和受试者工作特征（ROC）分析显示，第四脑室与肿瘤体积比≤0.02（OR 33.1，95%CI 3.8 - 284.3，p = 0.001）、水肿与肿瘤体积比≤0.85（OR 10.6，95%CI 2.4 - 47.4，p = 0.002）、与第四脑室的影像形态接触（OR 5，95%CI 1.4 - 18，p = 0.013）以及多发颅内转移（OR 2.4，95%CI 1 - 5.9，p = 0.045）是手术相关术后脑积水发生的独立预测因素。
结论
本研究确定了PFMs手术后术后脑积水发生的术前可检测危险因素。这些发现可能为预防性EVD放置的临床决策提供指导。
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