Background Intracranial infection is a common postoperative complication of neurosurgery. This study aimed to identify risk factors of postoperative intracranial infection in patients with cerebrospinal fluid rhinorrh...Background Intracranial infection is a common postoperative complication of neurosurgery. This study aimed to identify risk factors of postoperative intracranial infection in patients with cerebrospinal fluid rhinorrhea and to suggest proposals for the prevention. Methods A total of 167 patients （113 males and 54 males, average age of 34.4 years） with cerebrospinal fluid rhinorrhea operated on by the senior author were retrospectively reviewed. The data collected included etiology, previous history, clinical manifestation, site of bone defect, operative approach, and postoperative complications. Risk factor（s） for postoperative infection were analyzed using the stepwise multiple Logistic regression. Results Eighteen （10.8%） patients were infected post-operatively. The independent risk factors for infection were the site of defect （RR=0.508, 95% Cl 0.306-0.843, P=0.009） and historical meningitis （RR=0.290, 95% Cl 0.094-0.893, P=0.031）. Patients with multiple defects and saddle floor defects had a higher infection rate. The germiculture was positive in 11 patients, and vancomycin was sensitive to all the pathogenesis. Nine infected patients needed lumbar drainage. Ten patients had hyponatremia, and hydrocephalus occurred in two patients with serious trauma. Conclusions To prevent the infection, we should pay closer attention to the high-risk patients pre-operation. During the operation, the methods those can improve wound healing, such as using blood-supply materials, reliable fixation, and eliminating dead space are all helpful. Conducting lumbar drainage and choosing effective prophylactic antibiotics in the early postoperative stage for the high-risk patients are methods of postoperative management.展开更多
Background Carbon dioxide （CO2） laser soldering is an alternative technique for tissue bonding.Basic fibroblast growth factor （bFGF） and transforming growth factor β1 （TGFβ1） are two key factors for wound heal...Background Carbon dioxide （CO2） laser soldering is an alternative technique for tissue bonding.Basic fibroblast growth factor （bFGF） and transforming growth factor β1 （TGFβ1） are two key factors for wound healing.This study was performed to demonstrate the efficacy of CO2 laser soldering for dural reconstruction and the effect of bFGF and TGFβ1 on healing.Methods In Part Ⅰ,10 minipigs were randomized into two equal groups.Dural defects were reconstructed by conventional fibrin glue bonding （group Ⅰa） or CO2 laser soldering （group Ⅰb）.The reconstructed dura was subjected to burst pressure （BP） measurement and immunohistochemical staining after 1 week.In Part Ⅱ,36 minipigs were randomized into three equal groups.Dural reconstruction was achieved by CO2 laser soldering.Exogenous bFGF （group Ⅱb） or TGFβ1 （group Ⅱc） was administered while group Ⅱa served as a control group.The specimens were subjected to BP measurement after 1,2,3,and 4 weeks,respectively.Results In Part Ⅰ,the dura specimens displayed positive staining of only bFGF in group la and of both bFGF and TGFβ1 in group lb.Group Ⅰb showed higher BP than group la （（98.00-±21.41） mmHg vs.（70.80±15.09） mmHg,respectively; P 〈0.05）.In Part Ⅱ,BP of group Ⅱc was significantly higher than that of group Ⅱla （P 〈0.01）.The BP of group Ⅱa trended toward stabilization after 3 weeks of growth,while that of groups lⅡb and Ⅱc trended toward stabilization after 2 weeks of growth.Conclusions CO2 laser soldering is a reliable technique for dural reconstruction.The superior healing of dural reconstruction by CO2 laser soldering may be related to higher expression of bFGF and TGFβ1,and CO2 lasers may stimulate their secretion.Exogenous bFGF or TGFβ1 may improve healing by shortening the wound healing time,and exogenous TGFβ1 may improve the tensile strength.展开更多
文摘Background Intracranial infection is a common postoperative complication of neurosurgery. This study aimed to identify risk factors of postoperative intracranial infection in patients with cerebrospinal fluid rhinorrhea and to suggest proposals for the prevention. Methods A total of 167 patients （113 males and 54 males, average age of 34.4 years） with cerebrospinal fluid rhinorrhea operated on by the senior author were retrospectively reviewed. The data collected included etiology, previous history, clinical manifestation, site of bone defect, operative approach, and postoperative complications. Risk factor（s） for postoperative infection were analyzed using the stepwise multiple Logistic regression. Results Eighteen （10.8%） patients were infected post-operatively. The independent risk factors for infection were the site of defect （RR=0.508, 95% Cl 0.306-0.843, P=0.009） and historical meningitis （RR=0.290, 95% Cl 0.094-0.893, P=0.031）. Patients with multiple defects and saddle floor defects had a higher infection rate. The germiculture was positive in 11 patients, and vancomycin was sensitive to all the pathogenesis. Nine infected patients needed lumbar drainage. Ten patients had hyponatremia, and hydrocephalus occurred in two patients with serious trauma. Conclusions To prevent the infection, we should pay closer attention to the high-risk patients pre-operation. During the operation, the methods those can improve wound healing, such as using blood-supply materials, reliable fixation, and eliminating dead space are all helpful. Conducting lumbar drainage and choosing effective prophylactic antibiotics in the early postoperative stage for the high-risk patients are methods of postoperative management.
基金This research project was supported by grants from the National Natural Science Foundation of China （No.30870752） and Beijing Natural Science Foundation （No.3092012）.
文摘Background Carbon dioxide （CO2） laser soldering is an alternative technique for tissue bonding.Basic fibroblast growth factor （bFGF） and transforming growth factor β1 （TGFβ1） are two key factors for wound healing.This study was performed to demonstrate the efficacy of CO2 laser soldering for dural reconstruction and the effect of bFGF and TGFβ1 on healing.Methods In Part Ⅰ,10 minipigs were randomized into two equal groups.Dural defects were reconstructed by conventional fibrin glue bonding （group Ⅰa） or CO2 laser soldering （group Ⅰb）.The reconstructed dura was subjected to burst pressure （BP） measurement and immunohistochemical staining after 1 week.In Part Ⅱ,36 minipigs were randomized into three equal groups.Dural reconstruction was achieved by CO2 laser soldering.Exogenous bFGF （group Ⅱb） or TGFβ1 （group Ⅱc） was administered while group Ⅱa served as a control group.The specimens were subjected to BP measurement after 1,2,3,and 4 weeks,respectively.Results In Part Ⅰ,the dura specimens displayed positive staining of only bFGF in group la and of both bFGF and TGFβ1 in group lb.Group Ⅰb showed higher BP than group la （（98.00-±21.41） mmHg vs.（70.80±15.09） mmHg,respectively; P 〈0.05）.In Part Ⅱ,BP of group Ⅱc was significantly higher than that of group Ⅱla （P 〈0.01）.The BP of group Ⅱa trended toward stabilization after 3 weeks of growth,while that of groups lⅡb and Ⅱc trended toward stabilization after 2 weeks of growth.Conclusions CO2 laser soldering is a reliable technique for dural reconstruction.The superior healing of dural reconstruction by CO2 laser soldering may be related to higher expression of bFGF and TGFβ1,and CO2 lasers may stimulate their secretion.Exogenous bFGF or TGFβ1 may improve healing by shortening the wound healing time,and exogenous TGFβ1 may improve the tensile strength.
