Objectives:Appropriate scenarios of lumbar drain(LD)use in endonasal skull base surgery is an active area of investigation.However,existing data is limited.The purpose of this study is to evaluate the robustness of th...Objectives:Appropriate scenarios of lumbar drain(LD)use in endonasal skull base surgery is an active area of investigation.However,existing data is limited.The purpose of this study is to evaluate the robustness of the NSQIP database to characterize morbidity and complications associated with LD usage concurrent to minimally invasive resection of pituitary tumors.Methods:A cross-sectional analysis of the American College of Surgeons National Surgical Quality Improvement Program database was used to query patients undergoing transnasal resection of pituitary tumor.Patients were stratified by concurrent perioperative use of LD and outcomes were compared.Results:A total of 1714 patients underwent minimally invasive endonasal(microscopic or endoscopic)pituitary tumor resection,of which LD was concurrently placed in 98(5.7%)cases.Operative time was significantly longer for patients who had LD placed compared to those without(176.5 min(IQR 114.8-229.5)vs.137 min[IQR 100-185]),(p<0.001)with a significantly longer length of stay(5 days[IQR 4-6]vs.3 days[IQR 2-5]),(p<0.001).Multivariate regression demonstrated LD placement was an independent predictor of postoperative medical complication(OR 2.41,95%CI 1.15-5.03,p=0.020)and unplanned readmission(OR 2.06,95%CI 1.02-4.16,p=0.044),but not CSF leak(OR 2.30,95%CI 0.51-10.26;p=0.276).Temporal analysis during the study period demonstrated a decrease in LD use from 8%to 5%(R2=0.60;p=0.025).Conclusions:The NSQIP database provides a large patient population for examining LD use in endoscopic pituitary adenoma resection.LD use for minimally invasive pituitary surgery is associated with postoperative medical complications and unplanned readmissions,with no apparent impact on reconstructive outcomes,and there is overall decreasing usage.Clinical judgment should be exercised in selecting appropriate scenarios for use.展开更多
Background: Spontaneous CSF leak represents less frequent cause of CSF leak, but cases are more difficult to control, with the highest failure rate and recurrence despite adequate repair. The problems in these cases m...Background: Spontaneous CSF leak represents less frequent cause of CSF leak, but cases are more difficult to control, with the highest failure rate and recurrence despite adequate repair. The problems in these cases might be related to an underlying undiagnosed associated intracranial hyper-tension. Recognition and long-term treatment of elevated ICP is therefore critical to the successful management of these patients. Objective: To evaluate the CSF pressure in cases of spontaneous CSF rhinorrhea and to describe our same setting combined protocol to the repair of the leak, measurement and management of CSF pressure. Patients and Methods: All patients presenting to Ain Shams University Hospitals, Cairo, Egypt, with spontaneous CSF leak were included prospectively in the study. Clinical and radiologic data were collected to suspect elevated intracranial pressure. After CSF repair, CSF pressure was measured and if found to be more than 20 cmH2O, a lumboperitoneal shunt was used. Results: Twenty-seven cases, 23 women and 4 men, presented with spontaneous CSF leak. 23 patients had BMI above 30. All patients had empty sella syndrome (100%), and a meningoencephalocele was found in 13 cases (48%). CSF pressure ranged from 5 to 39 cmH2O (mean = 28.7). A pressure above 21 cmH2O was found in19 patients (70%) and subsequently had lumboperitoneal shunt in the same setting. No recurrence occurred in this subset of patients with 6 - 60 months follow-up period. Conclusion: A selective and specific same setting protocol can result in a better diagnosis and control of the accompanying elevated ICP in cases of spontaneous CSF leak. It avoids a second operative intervention, and shortens the hospital stay, with an increase in the success rate. In the same time, the smaller number of patients with normal ICP can avoid further drainage.展开更多
文摘Objectives:Appropriate scenarios of lumbar drain(LD)use in endonasal skull base surgery is an active area of investigation.However,existing data is limited.The purpose of this study is to evaluate the robustness of the NSQIP database to characterize morbidity and complications associated with LD usage concurrent to minimally invasive resection of pituitary tumors.Methods:A cross-sectional analysis of the American College of Surgeons National Surgical Quality Improvement Program database was used to query patients undergoing transnasal resection of pituitary tumor.Patients were stratified by concurrent perioperative use of LD and outcomes were compared.Results:A total of 1714 patients underwent minimally invasive endonasal(microscopic or endoscopic)pituitary tumor resection,of which LD was concurrently placed in 98(5.7%)cases.Operative time was significantly longer for patients who had LD placed compared to those without(176.5 min(IQR 114.8-229.5)vs.137 min[IQR 100-185]),(p<0.001)with a significantly longer length of stay(5 days[IQR 4-6]vs.3 days[IQR 2-5]),(p<0.001).Multivariate regression demonstrated LD placement was an independent predictor of postoperative medical complication(OR 2.41,95%CI 1.15-5.03,p=0.020)and unplanned readmission(OR 2.06,95%CI 1.02-4.16,p=0.044),but not CSF leak(OR 2.30,95%CI 0.51-10.26;p=0.276).Temporal analysis during the study period demonstrated a decrease in LD use from 8%to 5%(R2=0.60;p=0.025).Conclusions:The NSQIP database provides a large patient population for examining LD use in endoscopic pituitary adenoma resection.LD use for minimally invasive pituitary surgery is associated with postoperative medical complications and unplanned readmissions,with no apparent impact on reconstructive outcomes,and there is overall decreasing usage.Clinical judgment should be exercised in selecting appropriate scenarios for use.
文摘目的分析经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)治疗腰椎退行性疾病术后引流量增加的危险因素。方法选取2020-01/2022-12月因腰椎退行性疾病在作者医院就诊、接受经TLIF且术后引流量数据记载详细的65例患者进行回顾性研究。根据总引流量进行分组,分为引流量正常组(n=32)与引流量增加组(n=33)。比较两组患者的一般资料,通过单因素分析和多因素Logistic回归分析确定两组患者TLIF后引流量增加的危险因素,通过受试者工作特征(receiver operating characteristic,ROC)曲线分析相关危险因素的预测价值。结果引流量增加组患者的年龄、并发症的比例、手术时间、失血量、术前D-二聚体水平、术后第1天引流量均明显大于引流量正常组,而术前血红蛋白、术后白蛋白、术前白细胞计数和术后血小板计数明显低于引流量正常组,差异具有统计学意义(P均<0.05)。Logistic回归分析显示,术中失血量和术后第1天引流量是TLIF术后引流量增加的独立危险因素(P<0.05)。ROC曲线分析结果显示,术前血红蛋白、失血量、术后第1天引流量联合预测模型的曲线下面积(area under the curve,AUC)为0.937,灵敏度为0.818,特异度为0.906,临界值为0.59,联合模型预测腰椎退行性疾病患者TLIF后引流量增加的AUC高于任何单一因素。结论术中失血量、术后第1天引流量是TLIF术后引流量增加的独立危险因素,术前血红蛋白可能是引流量增加的保护因素。联合失血量、术后第1天引流量和术前血红蛋白的回归模型对腰椎退行性疾病患者TLIF后引流量增加的预测价值较高。
文摘Background: Spontaneous CSF leak represents less frequent cause of CSF leak, but cases are more difficult to control, with the highest failure rate and recurrence despite adequate repair. The problems in these cases might be related to an underlying undiagnosed associated intracranial hyper-tension. Recognition and long-term treatment of elevated ICP is therefore critical to the successful management of these patients. Objective: To evaluate the CSF pressure in cases of spontaneous CSF rhinorrhea and to describe our same setting combined protocol to the repair of the leak, measurement and management of CSF pressure. Patients and Methods: All patients presenting to Ain Shams University Hospitals, Cairo, Egypt, with spontaneous CSF leak were included prospectively in the study. Clinical and radiologic data were collected to suspect elevated intracranial pressure. After CSF repair, CSF pressure was measured and if found to be more than 20 cmH2O, a lumboperitoneal shunt was used. Results: Twenty-seven cases, 23 women and 4 men, presented with spontaneous CSF leak. 23 patients had BMI above 30. All patients had empty sella syndrome (100%), and a meningoencephalocele was found in 13 cases (48%). CSF pressure ranged from 5 to 39 cmH2O (mean = 28.7). A pressure above 21 cmH2O was found in19 patients (70%) and subsequently had lumboperitoneal shunt in the same setting. No recurrence occurred in this subset of patients with 6 - 60 months follow-up period. Conclusion: A selective and specific same setting protocol can result in a better diagnosis and control of the accompanying elevated ICP in cases of spontaneous CSF leak. It avoids a second operative intervention, and shortens the hospital stay, with an increase in the success rate. In the same time, the smaller number of patients with normal ICP can avoid further drainage.
