Schiariti Marco Paolo, Mazzapicchi Elio, Gemma Marco, Pasquale Erica, Restelli Francesco, Ciceri Elisa Francesca Maria, Falco Jacopo, Broggi Morgan, DiMeco Francesco, Ferroli Paolo, Acerbi Francesco
Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Via Giovanni Celoria 11, 20133, Milan, Italy.
Department of Neuroanesthesia and Intensive Care, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy.
Neurosurg Rev. 2024 Dec 9;47(1):896. doi: 10.1007/s10143-024-03142-0.
Despite being uncommon, postoperative vasospasm (PoVS) present notably high morbidity and mortality rates. Our aim was to identify prognostic factors associated with this condition and introduce a scoring system to improve subsequent clinical and radiological surveillance strategies. We conducted a retrospective analysis of our institutional database covering patients aged over 18 who underwent craniotomic or transsphenoidal surgery for elective tumor removal at the Neurosurgical Unit of our institution between January 2016 and August 2023. A comprehensive search was conducted using the Cochrane Database of Systematic Reviews and PubMed database to identify the most correlated risk factors. Literature review included a final group of 32 studies (52 patients) and identified SAH, vessel encasement or vessel manipulation, hypothalamic disfunction, meningitis, younger age, tumor size > 3 cm, and long operative time as predictive factors for PoVS. Our cohort included 2132 patients, with only 13 individuals (0.61%) presenting PoVS. To predict the occurrence of PoVS, we developed a logistic multivariate regression model that identified thick (defined as Fisher grade ≥ 3) subarachnoid hemorrhage (coeff. 6.7, p < 0.001), intraparenchymal hemorrhage (coeff. 3.44, p < 0.001), lesion located in the parasellar region (coeff. 2.1, p = 0.064), and lesion size ≥ 4 cm (coeff. 2.0, p = 0.069) as potential independent predictors of PoVS. Based on statistical model for these variables was assigned a score: thick SAH 7 points, intraparenchymal hemorrhage 3 points, parasellar lesion site 2 points, and lesion size ≥ 4 cm 2 points. The cumulative scores ranged from 0 to 14. PoVS is a rare complication but its association with significant morbidity and mortality underscores the importance of early identification and treatment. In our study we proposed a stratified risk score to identify high risk patients. However, due to rarity of this condition, our score proposal should be considered as a training set a to be validated in future studies with a multicenter setting.
尽管术后血管痉挛（PoVS）并不常见，但其发病率和死亡率却显著较高。我们的目的是确定与这种情况相关的预后因素，并引入一种评分系统，以改进后续的临床和放射学监测策略。我们对机构数据库进行了回顾性分析，该数据库涵盖了2016年1月至2023年8月期间在我们机构神经外科接受开颅手术或经蝶窦手术以选择性切除肿瘤的18岁以上患者。我们使用Cochrane系统评价数据库和PubMed数据库进行了全面检索，以确定最相关的风险因素。文献综述纳入了最终的32项研究（52例患者），并确定蛛网膜下腔出血（SAH）、血管包裹或血管操作、下丘脑功能障碍、脑膜炎、年龄较小、肿瘤大小>3 cm以及手术时间长为PoVS的预测因素。我们的队列包括2132例患者，只有13例（0.61%）出现PoVS。为了预测PoVS的发生，我们建立了一个逻辑多元回归模型，该模型确定厚（定义为Fisher分级≥3级）蛛网膜下腔出血（系数6.7，p<0.001）、脑实质内出血（系数3.44，p<0.001）、位于鞍旁区域的病变（系数2.1，p = 0.064）以及病变大小≥4 cm（系数2.0，p = 0.069）为PoVS的潜在独立预测因素。基于这些变量的统计模型分配了一个分数：厚SAH 7分、脑实质内出血3分、鞍旁病变部位2分以及病变大小≥4 cm 2分。累积分数范围为0至14分。PoVS是一种罕见的并发症，但其与显著的发病率和死亡率相关，这凸显了早期识别和治疗的重要性。在我们的研究中，我们提出了一个分层风险评分来识别高危患者。然而，由于这种情况罕见，我们的评分建议应被视为一个训练集，有待在未来多中心研究中进行验证。
