Risk factors for postoperative intracranial infections in patients with pituitary adenoma after endoscopic endonasal transsphenoidal surgery: pneumocephalus deserves further study
Risk factors for postoperative intracranial infections in patients with pituitary adenoma after endoscopic endonasal transsphenoidal surgery: pneumocephalus deserves further study
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DOI：
10.3171/2019.5.focus19269
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发表时间：
2019-08-01
影响因子：
4.1
通讯作者：
Jia, Dong
中科院分区：
文献类型：
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作者：
Guo, Kang;Heng, Lijun;Jia, Dong
目的 作者试图确定内镜经鼻蝶手术后的垂体腺瘤患者的脑积气与术后颅内感染之间的相关性，以及细菌学特征和颅内感染的危险因素。 方法 总共收集了 2014 年至 2018 年连续 251 名接受单纯内镜经鼻蝶手术的垂体腺瘤患者的数据。回顾性研究术前合并症、术中技术和术后护理。结果本回顾性研究发现术后脑积气18例（7.17%），中枢神经系统感染9例（3.59%），脑脊液漏12例（4.78%）。脑积气患者中，5 例（27.8%）有中枢神经系统感染。中枢神经系统感染患者中，培养结果阳性7例，阴性2例。统计分析提示，头积气（最大气泡直径≥1 cm）、膈肌缺损（术中脑脊液漏，Kelly分级≥1级）、术后脑脊液漏是术后中枢神经系统感染的危险因素。结论对于接受单纯内镜经鼻蝶手术的垂体腺瘤患者，术中鞍座重建对术后颅内感染患者具有至关重要的作用。此外，术后脑积气在预测颅内感染方面起着重要作用，不容忽视。因此，神经外科医生应密切关注术后颅内气脑的发现，因为该因素与术后脑脊液漏同样重要。头积气（最大气泡直径≥1cm）、膈肌缺损（术中脑脊液漏，Kelly分级≥1）和术后脑脊液漏是术后颅内感染的危险因素。此外，手术过程必须仔细进行，以避免膈肌缺损，减少与外部环境的接触，并减少患者的痛苦。
OBJECTIVE The authors sought to identify the relevance between pneumocephalus and postoperative intracranial infections, as well as bacteriological characteristics and risk factors for intracranial infections, in patients with pituitary adenomas after endoscopic endonasal transsphenoidal surgery.METHODS In total, data from 251 consecutive patients with pituitary adenomas who underwent pure endoscopic endonasal transsphenoidal surgeries from 2014 to 2018 were reviewed for preoperative comorbidities, intraoperative techniques, and postoperative care.RESULTS This retrospective study found 18 cases of postoperative pneumocephalus (7.17%), 9 CNS infections (3.59%), and 12 CSF leaks (4.78%). Of the patients with pneumocephalus, 5 (27.8%) had CNS infections. In patients with CNS infections, the culture results were positive in 7 cases and negative in 2 cases. The statistical analysis suggested that pneumocephalus (maximum bubble diameter of >= 1 cm), diaphragmatic defects (intraoperative CSF leak, Kelly grade >= 1), and a postoperative CSF leak are risk factors for postoperative CNS infections.CONCLUSIONS In pituitary adenoma patients who underwent pure endoscopic endonasal transsphenoidal surgeries, intraoperative saddle reconstruction has a crucial role for patients with postoperative intracranial infections. Additionally, postoperative pneumocephalus plays an important role in predicting intracranial infections that must not be neglected. Therefore, neurosurgeons should pay close attention to the discovery of postoperative intracranial pneumocephalus because this factor is as important as a postoperative CSF leak. Pneumocephalus (maximum bubble diameter of >= 1 cm), diaphragmatic defects (an intraoperative CSF leak, Kelly grade >= 1), and a postoperative CSF leak were risk factors predictive of postoperative intracranial infections. In addition, it is essential that operative procedures be carefully performed to avoid diaphragmatic defects, to reduce exposure to the external environment, and to decrease patients' suffering.