听神经瘤切除术后脑血管痉挛的危险因素分析

Risk factors of cerebral vasospasm after resection of acoustic neuroma

摘要:

探讨经乙状窦后入路切除听神经瘤患者术后脑血管痉挛发生的潜在危险因素。方法选取2010年1月-2015 年2月该院接受听神经瘤切除术患者153 例。术后病理结果显示听神经瘤，且经乙状窦后入路手术，按纳入和排除标准，回顾性分析其中80 例符合要求的患者，按照经颅多普勒对术前及术后1、3、5、7 和9 d的椎基底动脉、颈内动脉、大脑中动脉、大脑前动脉血流速度及频谱的监控结果，将其分为血管痉挛组（43例）和血管未痉挛组（37 例），分析两组患者一般资料及其临床相关指标，并采用多因素Logistic 回归分析影响听神经瘤患者术后脑血管痉挛发生的危险因素。结果两组患者年龄、肿瘤最大直径、肿瘤质地、与三叉神经或脑干粘连方面比较，差异有统计学意义（ p<0.05）。多因素Logistic回归分析结果显示，年龄（oR=0.936，p=0.035），肿瘤最大直径（OR=5.327，p=0.046），肿瘤质地（OR=143.757， p=0.023）为脑血管痉挛危险因素。结论 听神经瘤术前年龄较小、肿瘤直径较大，术中可见肿瘤质地较韧的患者易并发术后脑血管痉挛。

Abstract:

To analyze the risk factors of cerebral vasospasm following operation for acoustic neuroma. Methods From January 2010 to February 2015, 153 patients received acoustic neuroma operation via retrosigmoid approach in our hospital. According to inclusion and exclusion criteria, a retrospective analysis was performed on 80 patients who met the requirements. According to the flow velocity and spectra of the vertebrobasilar artery, internal carotid artery, middle cerebral artery and anterior cerebral artery monitored by transcranial Doppler before operation and on the 1st, 3rd, 5th, 7th and 9th day after operation, the 80 patients were divided into vasospasm group (43 cases) and non-vasospasm group (37 cases). General data and clinical indexes of the two groups were analyzed. Multivariate logistic regression analyses were conducted to investigate the risk factors of cerebral vasospasm following operation for acoustic neuroma. Results There were significant differences in age, the maximum tumor diameter, tumor texture and adhesion to the trigeminal nerve or brain stem between the two groups ( p< 0.05). Younger age, larger tumor and firm tumor consistency were the risk factors of vasospasm ( p< 0.05). Conclusions Younger age, larger tumor and firm tumor consistency are the risk factors of cerebral vasospasm.