手术体位对前庭神经鞘瘤术后颅内积气的影响

Effect of surgical position on postoperative intracranial pneumatosis in patients with vestibular schwannoma

目的 探讨手术体位对前庭神经鞘瘤术后颅内积气的影响。方法 回顾性分析2017年6月至2020年12月手术治疗的103例听神经瘤的临床资料,其中采用侧卧位手术31例,坐位手术72例。术后24 h内复查CT,应用Mimics Medical 19软件计算处颅内气体体积。结果 术后24 h内复查CT显示,103例术后均出现颅内积气,其中硬膜下积气98例(95.15%),脑室内积气5例(4.85%);颅内空气体积中位数为8.238 ml(3.146-33.600 ml)。坐位手术病人颅内空气体积[18.776 ml(4.226-43.762 ml)]明显大于侧卧位手术病人[2.964 ml(1.059-7.720 ml);P<0.05]。多元线性回归分析显示,体位、年龄、手术时间是术后颅内积气的独立危险因素(P<0.05)。术后出现张力性气颅8例(7.77%),其中侧卧位手术1例(3.23%),坐位手术7例(9.72%),两组术后张力性气颅发生率无统计学差异(P>0.05);主要表现为术后意识障碍,无瞳孔改变、肢体麻痹、颅神经麻痹等,吸氧治疗后缓解,均未二次手术。结论 前庭神经鞘瘤手术时,坐位手术后颅内积气量高于侧卧位手术,但张力性气颅较少,且可自行缓解。这提示坐位手术后颅内积气的风险并不是该手术体位的禁忌症。

Objective To investigate the effect of surgical position on the postoperative intracranial pneumatosis in the patients with vestibular schwannoma. Methods The clinical data of 103 patients with vestibular schwannoma who underwent surgery from June2017 to December 2020 were retrospectively analyzed. Of 103 patients, 31 patients received operation in the lateral decubitus position(lateral group) and 72 in the sitting position(sitting group). CT scan was performed within 24 hours after operation, and the volume of intracranial gas was calculated by Mimics Medical 19 software. Results CT scans within 24 hours after operation showed that intracranial pneumatosis occurred in all the patients of whom 98 patients(95.15%) suffered from subdural pneumatosis and 5(4.85%)intraventricular pneumatosis. The medium volume was 8.238 ml(3.146-33.600 ml). The volume of intracranial gas in sitting group[18.776 ml(4.226-43.762 ml)] was significantly larger than that [2.964 ml(1.059-7.720 ml)] in lateral group(P<0.05). Multiple linear regression analysis showed that surgical position, age, and operation time were independent risk factors for the postoperative intracranial pneumatosis(P<0.05). Tension pneumocephalus occurred in 8 patients(7.77%) of whom 1 patient(3.23%) received operation in the lateral decubitus position and 7(9.72%) in sitting position. There was no significant difference between both groups(P>0.05). The main manifestations of tension pneumocephalus were disturbance of consciousness, without pupil changes, limb paralysis, cranial nerve paralysis, etc. Eight patients with tension pneumocephalus were relieved after oxygen inhalation treatment, without no second surgery.Conclusions During the operation for vestibular schwannoma, the intracranial volume after the sitting position is higher than that in the lateral position, but the tension pneumocephalus is less and can be relieved spontaneously. Our results suggest that the risk of intracranial pneumatosis is not a contraindication to the surgery in sitting position for the patients with vestibular schwannoma.