糖皮质激素在小儿后颅窝肿瘤手术中的应用与术后言语障碍的发生
Glucocorticoid use in paediatric posterior fossa tumour surgery and the occurrence of postoperative speech impairment.
作者信息
Sarup Rebekka, Laustsen Aske F, Sørensen Martin K, Mallucci Conor, Pizer Barry, Aquilina Kristian, Molinari Emanuela, Hjort Magnus Aasved, Frič Radek, Nyman Per, Sabel Magnus, Nilsson Pelle, Matukevičius Algimantas, Hauser Peter, Mudra Katalin, Carai Andrea, Zipfel Julian, Hoving Eelco, van Baarsen Kirsten, IIIrd Vladimír Beneš, Peyrl Andreas, Nysom Karsten, Sehested Astrid Marie, Schmiegelow Kjeld, Juhler Marianne, Grønbæk Jonathan K, Mathiesen René
机构信息
Department of Neurosurgery, The University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen E, Denmark.
Department of Paediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen E, Denmark.
出版信息
Childs Nerv Syst. 2025 Jul 11;41(1):231. doi: 10.1007/s00381-025-06850-0.
PURPOSE
Postoperative speech impairment (POSI) is a core symptom of cerebellar mutism syndrome (CMS) and is a common complication after the resection of paediatric posterior fossa (PF) tumours. Preoperative glucocorticoids (pGC) are considered standard treatment to reduce tumour oedema; in addition, glucocorticoids are often administered intraoperatively (iGC) to reduce both postoperative nausea and vomiting. The study aims to investigate whether the occurrence of POSI may be associated with pGC and iGC.
METHODS
In a prospective observational multicentre study, we included children with a PF tumour requiring either resection or open biopsy. The use of pGC and iGC, including drug type and dose, was registered. Postoperative speech status was classified as mutism, reduced speech, or habitual speech, where mutism and reduced speech were considered POSI of higher and lower severity, respectively. Proportional odds logistic regression with adjustment for tumour type, tumour location, and age was used to analyse the occurrence of POSI associated with glucocorticoids (GC).
RESULTS
From August 2014 to November 2024, we recruited 810 children, of whom 605 were included in the primary analysis. We found no association between the use of GC (pGC nor iGC) and the occurrence of POSI. The result did not change when adjusting for tumour type, tumour location, and age. The analysis included both a comparison between using and not using pGC (OR 1.06 [95% CI 0.46 -2.49], reference level: use of pGC) and/or iGC (1.28 [0.58-2.82], reference level: use of iGC), and a dose-response analysis of the occurrence of POSI in relation to doubling the dose of GC (pGC OR 1.28 [0.84-1.98]; iGC OR 1.07 [0.62-1.82]).
CONCLUSION
Our study did not find evidence of a significant change in the occurrence of POSI with the use of pGC or iGC, but our results alone cannot rule out that the administration of pGC or iGC may have some effect. Therefore, our data do not call for a change in recommendations for the use of GC as protection against the development of POSI.
TRIAL REGISTRATION NUMBER
Clinicaltrials.gov (NCT02300766). Date of registration: November 25, 2014.
目的
术后言语障碍（POSI）是小脑缄默综合征（CMS）的核心症状，是小儿后颅窝（PF）肿瘤切除术后的常见并发症。术前使用糖皮质激素（pGC）被认为是减轻肿瘤水肿的标准治疗方法；此外，糖皮质激素常在术中使用（iGC）以减轻术后恶心和呕吐。本研究旨在调查POSI的发生是否可能与pGC和iGC有关。
方法
在一项前瞻性观察性多中心研究中，我们纳入了需要进行切除或开放活检的PF肿瘤患儿。记录pGC和iGC的使用情况，包括药物类型和剂量。术后言语状态分为缄默、言语减少或习惯性言语，其中缄默和言语减少分别被视为严重程度较高和较低的POSI。使用比例优势逻辑回归，并对肿瘤类型、肿瘤位置和年龄进行调整，以分析与糖皮质激素（GC）相关的POSI的发生情况。
结果
从2014年8月至2024年11月，我们招募了810名儿童，其中605名纳入了初步分析。我们发现GC（pGC和iGC）的使用与POSI的发生之间没有关联。在对肿瘤类型、肿瘤位置和年龄进行调整后，结果没有改变。分析包括使用和不使用pGC（比值比[OR]1.06[95%置信区间（CI）0.46 - 2.49]，参考水平：使用pGC）和/或iGC（1.28[0.58 - 2.82]，参考水平：使用iGC）的比较，以及POSI发生与GC剂量加倍相关的剂量反应分析（pGC OR 1.28[0.84 - 1.98]；iGC OR 1.07[0.62 - 1.82]）。
结论
我们的研究没有发现使用pGC或iGC会使POSI发生率发生显著变化的证据，但仅凭我们的结果不能排除使用pGC或iGC可能有一些影响。因此，我们的数据并不要求改变关于使用GC预防POSI发生的建议。
试验注册号
Clinicaltrials.gov（NCT02300766）。注册日期：2014年11月25日。
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