儿童围手术期因素与术后小脑缄默综合征发生之间的关联

文献信息

中文摘要

目的： 术后小脑缄默综合征（pCMS）是一种复杂的神经系统损害性疾病，包括缄默、肌张力低下和吞咽困难，主要发生于儿童幕下病变切除术后。虽然文献报道了若干术前危险因素，但关于外科医生的作用及围手术期因素知之甚少。因此，我们旨在探讨围手术期特征与pCMS之间的关联。
方法： 这项单中心研究纳入2013—2022年间接受小脑病变显微外科切除术的83例患者。采用粗化精确匹配按年龄将对照与病例匹配。共有20例pCMS患者。评估的参数包括年龄、性别、病变组织学以及改良鹿特丹风险评分。还检查了术中和围手术期因素，如手术入路、切除范围、地塞米松、血制品、凝血因子和甘露醇的使用、术前脑脊液（CSF）引流的使用，以及术后钠和血红蛋白水平。
结果： 粗效应分析显示pCMS与髓母细胞瘤组织学（比值比[OR]=7.40，95%置信区间[CI]=[1.75, 31.17]）以及血制品输注（OR=4.82，95% CI=[1.15, 20.16]）之间存在关联。此外，pCMS的发生与术后第1天的血红蛋白（OR=0.55，CI=[0.31, 0.96]）和钠（OR=1.21，95% CI=[1.00, 1.46]）水平之间存在显著关联。多变量分析证实了与髓母细胞瘤组织学的关联（OR=4.66，95% CI=[1.13, 19.15]）。
结论： 在多变量分析中，组织学是pCMS发生的唯一显著因素。尽管如此，在这项探索性分析中，有趋势提示血制品输注以及术后血红蛋白和钠水平可能代表pCMS发生的危险因素。

英文摘要

PURPOSE: Postoperative cerebellar mutism syndrome (pCMS) is a complex condition involving neurological impairment including mutism, hypotonia and dysphagia, that occurs after resection of infratentorial lesions predominantly in children. While the literature has reported several preoperative risk factors, there is little knowledge on the surgeon's role and perioperative factors. Thus, we aimed to examine the association between perioperative features and pCMS.
METHODS: This single-center study included 83 patients who underwent microsurgical resection of a cerebellar lesion in 2013-2022. Controls were matched to cases based on age using coarsened exact matching. There were 20 patients with pCMS. The parameters assessed included age, gender, the histology of the lesion, and the modified Rotterdam Risk Score. Intra- and perioperative factors such as the surgical approach; the extent of resection; the administration of dexamethasone, blood products, coagulative factors, and mannitol; the use of a preoperative cerebrospinal fluid (CSF) drain; and postoperative sodium and hemoglobin levels were examined.
RESULTS: Crude-effect analysis showed associations between pCMS and medulloblastoma histology (odds ratio [OR] = 7.40, 95% confidence interval [CI] = [1.75, 31.17]) and the administration of blood products (OR = 4.82, 95% CI = [1.15, 20.16]). Moreover, there was a significant association between the occurrence of pCMS and hemoglobin (OR = 0.55, CI = [0.31, 0.96]) and sodium (OR = 1.21, 95% CI = [1.00, 1.46]) levels on postoperative day 1. Multivariate analysis confirmed the association with medulloblastoma histology (OR = 4.66, 95% CI = [1.13, 19.15]).
CONCLUSION: In multivariate analysis, histology was the only significant factor for the development of pCMS. Nonetheless, there was a trend suggesting that the administration of blood products and the postoperative hemoglobin and sodium levels could represent risk factors for development of pCMS in this explorative analysis.