Study And Analysis Of Posterior Craniotomy Complications In 278 Patients With Posterior Fossa Diseases

Objective:This study was conducted on patients with posterior fossa lesions treated in the First Affiliated Hospital of Xiamen University.Exploring the postoperative complications related to craniotomy;analysing the potential influencing factors;summarizing the experience of posterior fossa surgery.Methds:We undertook a 10-year retrospective study of 278 patients with posterior fossa surgery admitted to the First Affiliated Hospital of Xiamen University from March 2011 to December 2017.The clinical manifestations,surgical approaches,pathology and complications were collected from the hospital database.They were sort into7 groups based on lesions and anatomic sites:(1)cerebellopontine angle lesion,(2)microvascular decompression for facial pain and spasm,(3)cerebellar lesions,(4)fourth ventricle,(5)brainstem,(6)petroclival lesions,(7)foramen magnum area.Analyzing the predisposing factors that might influence the complication rate;summarizing the experience of posterior fossa surgery.Results:(1)Of the 278 patients reviewed,108 cases were male,and 170 cases were female,with the average age of 47 years old.(2)105(37.8%)cases had microvascular decompression for trigeminal neuralgia and hemifacial spasm,72(25.9%)cases had cerebellopontine angle lesions,65(23.4%)cases had the tumor resection at the cerebellum,23(8.2%)cases had foramen magnum lesions,6(2.2%)cases had fourth ventricle tumors,5(1.8%)cases had petroclival lesions,and 2(0.7%)cases had brainstem tumors.(3)The overall complication rate is 31.3%,influencing 87 patients.The most common complication was peripheral facial paralysis in 32(11.5%)patients,followed by cerebrospinal fluid leaks in 24(8.6%)patients,intracranial nerve injury in 12(4.3%)patients,postoperative hemorrhage in 8(2.9%)patients,wound infection in 7(2.5%)patients,hydrocephalus in 5(1.8%)patients,intracranial infection in 5(1.8%)patients and cerebellar mutism in 3(1.1%)patients.The total mortality linked with surgery was 1.1%occurring in 3 patients.Conclusion:(1)The epidemiological characteristics and the incidence of postoperative complications of posterior fossa surgery in our group basically consistent the report.(2)The incidence of complications and mortality of posterior fossa surgery was higher than that of supratentorial surgery,and the types of complications were also various.(3)These complications may be avoided by proper preoperative preparation,strict aseptic adherence to aseptic technique,microsurgical operation,neuroelectrophysiological monitoring,appropriate surgical approach,tight suture wounds and reasonable use of artifical materials.(4)The surgeon was familiar with the patient’s medical history,neurological findings,anatomical structure of the skull base and image data with preoperative simulation may also reduce the incidence of postoperative complications.