The Relationship And Clinical Study Of Intracranial Infection And Cerebral Infarction After Endoscopic Endonasal Surgery

Objective:To explore the relationship between intracranial infection and cerebral infarction after endoscopic sellar surgery.Methods:From October 2017 to September 2018,in neurosurgery department of Tianjin Huanhu hospital,699 patients in sellar area and parasellar tumor surgery were selected as the research objects during the early stage of transnasal endoscopic surgery.Among them,141 patients were treated by endoscopic transnasal sphenoid sinus surgery,and 558 patients were treated by craniotomy at the same time.21 cases had intracranial infection,5 cases had cerebral infarction,39 cases had intracranial infection,2 cases had cerebral infarction.Firstly,the incidence of cerebral infarction after traditional craniotomy and transsphenoidal surgery was analyzed statistically.Secondly,the risk factors of cerebral infarction after endoscopic surgery were analyzed by single factor and multi factor Logistic regression analysis.The incidence,risk factors,prevention and treatment of postoperative intracranial infection with cerebral infarction were analyzed retrospectively.Results:21 cases of intracranial infection,5 cases of cerebral infarction(23.81%),39 cases of intracranial infection and 2 cases of cerebral infarction(5.13%)were analyzed retrospectively.There was a significant difference in the incidence of cerebral infarction after intracranial infection between the two groups(P < 0.05).According to the results of single factor analysis,the risk factors of postoperative cerebral infarction were age over 60 years old(P < 0.001),diabetes mellitus(P < 0.05),hypertension(P = 0.021)and intracranial infection(P < 0.001).Multivariate regression analysis showed that hypertension(P = 0.037)and intracranial infection(P = 0.003)were independent risk factors of postoperative cerebral infarction,and age ≥ 60 years(P = 0.109)were not independent risk factors of postoperative cerebral infarction.That is,patients with preoperative hypertension and postoperative intracranial infection lead to a higher risk of postoperative cerebral infarction.Conclusion:This study preliminarily showed that the incidence of infection related cerebral infarction was significantly higher in endoscopic surgery than that after craniotomy,and the possibility of cerebral infarction was increased by intracranial infection after transsphenoidal surgery.With the development of surgical techniques and the improvement of infection prevention and control measures,the incidence of cerebral infarction caused by infection and its later stage is expected to decrease gradually.Although the death of cerebral infarction after neurosurgery can be caused by many factors,the complications of cerebral infarction after endoscopic transsphenoidal surgery are serious,so it is more important to control the intracranial infection strictly.