| BACKGROUNDS:Posterior fossa surgery is a difficult operation in neurosurgery.And postoperative central nervous system infection is a common complication.It is found that the incidence of intracranial infection after posterior fossa surgery was 3 to four point six times higher than cerebellum superior craniotomy[1-2].Postoperative intracranial infection will improve the mortality and disability rate of patients,and increase the economic burden of patients.A large number of literatures have reported that CSF leakage is a risk factor for intracranial infection.Particularly the incidence of intracranial infection complicated with CSF leakage after posterior fossa surgery is 4.752 times higher than that without CSF leakage[3].Therefore,effective prevention of CSF leakage after posterior fossa surgery can significantly reduce the incidence of intracranial infection after posterior fossa surgery.Therefore,the study on the high risk factors of CSF leakage after posterior fossa surgery can provide early help for the prevention of cerebrospinal fluid leakage and even intracranial infection.OBJECTIVE:To retrospectively analyze the high-risk factors of incision cerebrospinal fluid leakage after posterior fossa surgery in order to provide early help for the prevention of incisional cerebrospinal fluid leakage,thereby reducing the incidence of intracranial infection and the mortality and disability rate caused by postoperative intracranial infection.METHODS:The cases of cranial fossa surgery were performed from January 1,2012 to November 30,2018,in Department of Neurosurgery,Huaihe Hospital,Henan University.The disease involved cerebellar tonsil malformation,cerebellar hemorrhage,subtentorial meningioma,cerebellar tumor,occipital cistern cyst,fourth ventricle tumor,CPA occupation,trigeminal neuralgia,facial spasm,glossopharyngeal neuralgia,occipital foramen mass occupation,cerebellar massive infarction,cerebral stem hemorrhage,chordoma ramus.A total of 358 cases were collected,excluding cases of death due to other causes within 7days due to incomplete medical history and emergency trauma patients.SPSS23.0 was used for R×C?2 test of the following indicators,and unifactorial analysis was performed:age,gender,whether the dura mater is tightly sewn up or not,drainage tube,hypertension,diabetes mellitus,intraoperative use of artificial dura mater,intraoperative use of biological glue,GCS,postoperative incision leakage before intracranial infection,whether to put back the skull and operative time;The differences in endocranium suture,drainage tube,GCS and operative time survival rate?P<0.05?were obtained.Since the independent variables of drainage tube were classified as no drainage tube,epidural drainage tube and subdural drainage tube,multiple comparisons of variance analysis were conducted on this group of data,aiming at the important factors of incisional cerebrospinal fluid leakage,after posterior fossa surgery.Multivariate Logistic regression analysis was performed to analyze dura mater suture,GCS and operation time.In addition,variance analysis was used to analyze the treatment measures of 46 patients with incisional cerebrospinal fluid leakage.There are two different treatments:1.Simpler-suturing of the wound 2.Re-suturing of the wound+Cerebrospinal fluid lumbar drainage.RESULTS:Single factor analysis was used for age,gender,dura mater whether strict suture,drainage tube,hypertension,diabetes,intraoperative use of artificial dura mater,intraoperative use of xanthan gum,GCS,postoperative incision leakage whether there is intracranial infection before postoperative incision leakage,whether to put back the skull,and R×C?2 test during operation time.Single factor analysis hint:the fact that dura mater was not tight sutured,drainage tube,GCS and operation time are important factors of incisional cerebrospinal fluid leakage,of incision posterior fossa?P<0.05?,and there's a rate difference.Then Multiple comparison of the drainage tube group were performed by anova.When comparing the group with the drainage tube placed under the dura and the group without the drainage tube placed,it's found P=0.000<0.05.Comparing the subdural drainage tube and the epidural drainage tube,it's found P=0.000<0.05.When comparing the group with epidural drainage tube and the group without epidural drainage tube,it's found P=0.376>0.05.The fact that dura mater without close suture,drainage tube placed under dura mater,GCS 12,operation time>4 hours may be a risk factor for incisional cerebrospinal fluid leakage after posterior fossa surgery.Multivariate Logistic regression analysis was conducted on endocranium suture,GCS and operation time.Then Results were obtained,the operative time P=0.11>0.05,although OR=2.084,the GCS OR=0.282,P=0.018<0.05,and B=-1.267,endocranium suture status OR=157.782,P=0.000<0.05,B=5.061.GCS and mater suture have statistical significance,indicating that the GCS less than or equal to 12 may be the independent risk factor for the formation of incisional cerebrospinal fluid leakage.In the two groups of different treatment measures,the effective rate of simple suture was 27.28%,the effective rate of leakage suture+Cerebrospinal fluid lumbar drainage was 84.62%,?2=12.479,P=0.000<0.05.Conclusions:1.The risk factors for incisional cerebrospinal fluid leakage after posterior fossa surgery are the fact that the dura mater is not tightly sewn,placement of drainage tube under dura mater,GCS less than 12,and operation time more than 4 hours.Among them,endocranium unclosed suture and GCS less than 12 may be independent risk factors for incisional cerebrospinal fluid leakage,after posterior fossa surgery.2.The effective rate of re-suturing of the wound combined with Cerebrospinal fluid lumbar drainage?LD?for incisional cerebrospinal fluid leakage,after posterior fossa surgery is obviously better than that of simple re-suturing of the wound. |
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