Craniectomy Versus Craniotomy for Posterior Fossa Metastases: Complication Profile

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• 作者：Amir Hadanny¹ ; Uri Rozovski² ; Erez Nossek¹ ; Yuval Shapira¹ ; Ido Strauss¹ ; Andrew A. Kanner¹ ; Razi Sitt¹ ; Zvi Ram¹ ; Tal Shahar¹ ; ^{talsh5@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Brain metastases ; Complications ; Craniectomy ; Craniotomy ; Posterior fossa ; Suboccipital
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：89
• 期：Complete
• 页码：193-198
• 全文大小：3474 K

文摘

Surgical resection of posterior fossa metastases (PFM) includes either suboccipital craniotomy or suboccipital craniectomy. The optimal surgical technique is yet to be defined. We examined the association between the chosen surgical approach and the occurrence of postoperative complications.

Methods

We retrospectively evaluated medical records and imaging characteristics of patients who underwent resection of newly diagnosed PFM between 2003 and 2014 in our medical center to identify covariates that significantly affected postoperative complications.

Results

Of 917 patients with brain metastases, 88 patients underwent surgery for PFM and were included in the study. Craniectomy was performed in 54 cases (61%). Urgent postoperative posterior fossa decompression or cerebrospinal fluid diversion was performed in 4 patients (4.5%). Postoperative complications included postoperative central nervous system infection (m>nm> = 10 [12%]), cerebrospinal fluid leak (m>nm> = 3 [4%]), wound dehiscence (m>nm> = 6 [7%]), and long-term pseudomeningocele (m>nm> = 12 [14%]). The perioperative mortality rate was 2.3% (m>nm> = 2). Multivariate analysis that included patient baseline characteristics, imaging study parameters, and surgical approaches demonstrated that suboccipital craniectomy was associated with more postoperative complications (m>Pm> = 0.03, odds ratio = 4.48, 95% confidence interval = 1.14–17.6). There was no correlation between patient baseline characteristics or surgical technique with the need for urgent postoperative posterior fossa decompression or cerebrospinal fluid diversion.

Conclusions

Suboccipital craniotomy may be associated with a lower incidence of postoperative morbidity compared with suboccipital craniectomy and should be considered as the preferred approach for the resection of PFM.