开颅手术切口脑脊液漏的处理及硬脑膜成形术中的“折叠技术”。

IF 3.3 2区 医学 Q2 CLINICAL NEUROLOGY
Eyup Bayatli, Onur Ozgural, Engin Erdin, Ümit Karadagoglu, Gokmen Kahilogullari, Hasan Caglar Ugur, Hakan Tuna, Ayhan Attar, Agahan Unlu, Y Sukru Caglar, Ihsan Dogan
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引用次数: 0

摘要

目的:回顾我院开颅手术患者医源性切口脑脊液泄漏的发生率,探讨其预防和处理方法。作者还讨论了“折叠技术”在硬脑膜成形术中作为传统硬脑膜重建技术的替代方法的实用性。方法:对所有开颅手术患者进行回顾性分析,并对有切口脑脊液泄漏的患者进行分析。脑脊液渗漏采用保守的非手术方法或手术干预。当保守的非手术方法无法控制泄漏时,考虑采用腰椎蛛网膜下腔引流(LED)、脑室外引流(EVD)、腰腹腔或脑室腹腔分流(VPS)等手术方法,并重新探查手术部位。结果:2019年至2024年,2149例患者因颅脑病变在我院接受开颅手术;39例(1.8%)患者术后出现切口脑脊液漏。大多数需要手术的病变位于幕上区(76.9%)。根据采用硬脑膜闭合技术的类型对患者进行分类。采用原始缝合、患者筋膜或合成硬脑膜(可吸收、不可吸收或两者兼而有之)进行硬脑膜重建。无放疗史的患者手术至渗漏发生的中位时间间隔为19 (IQR 1 ~ 79)天;然而,接受放疗的患者的持续时间更长(中位45 [IQR 10-540]天)。脑脊液漏的手术干预分为伤口缝合(结合其他保守方法,如收紧敷料和抬高床头端)、LED或EVD或手术再探查。硬脑膜成形术中的折叠技术是一种简单的方法,即使使用自体移植物或合成材料也能达到水密硬脑膜成形术。结论:切口脑脊液漏是一种发病率高、可预防的并发症。此类病例可通过保守方法处理,包括伤口缝合、LED或EVD、手术再探查。然而,管理策略超出了任何严格的算法。这种折叠硬脑膜成形术是一种有价值的替代传统的硬脑膜修复或重建术,用于颅脑甚至脊柱缺陷。本研究强调了在初次手术中恢复硬脑膜水密性的重要性,以防止任何进一步的干预和降低总体发病率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Management of incisional cerebrospinal fluid leak in open cranial surgeries and the "folding technique" in duraplasty.

Objective: The aim of this study was to review a series of patients who underwent open cranial surgeries to evaluate the incidence of iatrogenic incisional CSF leaks and discuss its prevention and management. The authors also discuss the utility of the "folding technique" used in duraplasty as an alternative to conventional dural reconstruction techniques.

Methods: All patients undergoing open cranial surgery were reviewed, and those with incisional CSF leak were included in this study. CSF leakage was managed using either conservative nonsurgical methods or surgical interventions. When the conservative nonsurgical methods failed to curb the leak, surgical procedures such as lumbar external drainage (LED) using lumbar subarachnoid drainage, external ventricular drainage (EVD), a lumboperitoneal or ventriculoperitoneal shunt (VPS), and reexploration of the surgical site were considered.

Results: Between 2019 and 2024, 2149 patients underwent open cranial surgeries at our hospital for any cranial pathology; 39 (1.8%) of these patients experienced postoperative incisional CSF leakage. The majority of the pathologies requiring surgeries were located in the supratentorial region (76.9%). Patients were classified according to the type of dural closure technique used. Primary stitching, the patient's fascia, or synthetic dura (resorbable, nonresorbable, or both) were used for dural reconstruction. The median interval between the surgery and the start of the leakage was 19 (IQR 1-79) days in patients with no history of radiotherapy; however, this duration was longer in patients who received radiotherapy (median 45 [IQR 10-540] days). The surgical interventions for CSF leakage were classified as wound resuturing (combined with other conservative approaches such as tightened dressing and elevating the head end of the bed), LED or EVD, or surgical reexploration. The folding technique in duraplasty is a simple way to achieve watertight duraplasty even with autograft or synthetic material.

Conclusions: Incisional CSF leakage is a potentially preventable complication with high morbidity. Such cases could be managed via conservative approaches including wound resuturing, LED or EVD, and surgical reexploration. However, the management strategy is beyond any strict algorithm. This folding technique for duraplasty is a worthy replacement for conventional primary suturing for dural repair or reconstruction in cranial and even spinal defects. This study highlights the importance of regaining the watertight nature of the dura in the primary surgery to prevent any further intervention and lower the overall morbidity.

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来源期刊
Neurosurgical focus
Neurosurgical focus CLINICAL NEUROLOGY-SURGERY
CiteScore
6.30
自引率
0.00%
发文量
261
审稿时长
3 months
期刊介绍: Information not localized
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