Dincer Alper, Tabor Joanna K, Pappajohn Alexandros F, O'Brien Joseph, Morales-Valero Saul, Kim Miri, Moliterno Jennifer
Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, United States.
Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States.
J Neurol Surg B Skull Base. 2024 Mar 18;86(2):234-242. doi: 10.1055/a-2263-1778. eCollection 2025 Apr.
Microvascular decompression (MVD) is the preferred treatment for refractory trigeminal neuralgia (TN) and hemifacial spasm (HFS). MVD provides long-lasting results for these conditions with a relatively low risk of postoperative complications. However, reoperation rates are reported up to 11%, an unacceptably high rate for an elective procedure. We determined what factors may increase the risk of reoperation among patients undergoing MVD for TN or HFS. Patient data from 2015 to 2020 were obtained from the American College of Surgeons-National Surgical Quality Improvement Program database and were included in this study if they had a procedure corresponding to an MVD with the current procedural terminology code 61458. Patient demographics, comorbidities, and outcomes were analyzed. Patients were subsequently categorized based on body mass index (BMI) and a logistic regression analysis was used to model the association of comorbidities with reoperation and its indication. The overall rate of reoperation in the cohort is 3.2 and 7.2% for patients with morbid obesity (BMI ≥ 40; = 0.006). Patients with morbid obesity were more likely to present at a younger age (50.1 vs. 57.4; < 0.0001), have comorbidities such as hypertension (60.9 vs. 33.5%; < 0.0001) and diabetes (16.3 vs. 7.7%; = 0.0002), and increased procedure duration (179 vs. 164 minutes; = 0.02). Indications for reoperation include cerebrospinal fluid (CSF) leak (31%), wound complications (19%), refractory pain (11.9), intracranial hemorrhage (4.8%), and other/unknown (33.3%). Patients with either morbid obesity or diabetes have a 2-fold increase in risk of reoperation, while having both is associated with a 5-fold risk of reoperation. We demonstrate morbid obesity leads to increased procedure duration and increased risk of reoperation due to wound complications and CSF leak. In these patients, alternative treatment strategies or preoperative optimization may be reasonable to reduce the risk of surgical complications and reoperation.
微血管减压术（MVD）是治疗顽固性三叉神经痛（TN）和半面痉挛（HFS）的首选方法。MVD可为这些病症提供持久疗效，且术后并发症风险相对较低。然而，据报道再次手术率高达11%，对于择期手术而言，这一比例高得令人难以接受。我们确定了哪些因素可能会增加接受MVD治疗TN或HFS患者的再次手术风险。
从美国外科医师学会-国家外科质量改进计划数据库中获取了2015年至2020年的患者数据，若其手术符合当前手术术语编码61458对应的MVD，则纳入本研究。分析了患者的人口统计学特征、合并症和手术结果。随后根据体重指数（BMI）对患者进行分类，并采用逻辑回归分析来模拟合并症与再次手术及其指征之间的关联。
该队列中再次手术的总体发生率，病态肥胖患者（BMI≥40）为3.2%，非病态肥胖患者为7.2%（P = 0.006）。病态肥胖患者更可能在较年轻的年龄就诊（50.1岁对57.4岁；P < 0.0001），患有高血压（60.9%对33.5%；P < 0.0001）和糖尿病（16.3%对7.7%；P = 0.0002）等合并症，且手术时间延长（179分钟对164分钟；P = 0.02）。再次手术的指征包括脑脊液（CSF）漏（31%）、伤口并发症（19%）、顽固性疼痛（11.9%）、颅内出血（4.8%）以及其他/不明原因（33.3%）。患有病态肥胖或糖尿病的患者再次手术风险增加2倍，而同时患有这两种疾病则与再次手术风险增加5倍相关。
我们证明病态肥胖会导致手术时间延长，以及因伤口并发症和脑脊液漏而增加再次手术风险。对于这些患者，采取替代治疗策略或术前优化措施可能有助于降低手术并发症和再次手术的风险。
