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Novel risk factors and management of brain sag after brain tumor surgery

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Title: Novel risk factors and management of brain sag after brain tumor surgery
Authors: Motegi, Hiroaki Browse this author →KAKEN DB
Yamaguchi, Shigeru Browse this author
Okamoto, Michinari Browse this author
Ishi, Yukitomo Browse this author →KAKEN DB
Endo, Shogo Browse this author
Kaneko, Sadahiro Browse this author
Kobayashi, Hiroyuki Browse this author →KAKEN DB
Terasaka, Shunsuke Browse this author →KAKEN DB
Houkin, Kiyohiro Browse this author →KAKEN DB
Keywords: Intracranial hypotension
Brain tumor
Cerebrospinal fluid
Lumber drain
Skull base
Risk factor
Brain sag
Issue Date: Mar-2021
Publisher: Elsevier
Journal Title: Interdisciplinary Neurosurgery-advanced Techniques And Case Management
Volume: 23
Start Page: 100951
Publisher DOI: 10.1016/j.inat.2020.100951
Abstract: Objective: Lumbar drains (LD) have been identified to cause brain sag (BS), which is a serious intracranial hypotension that causes coma; however, other contributing risk factors should also be considered. Therefore, this study aims to identify the BS risk factors and determine the proper treatment plan after brain tumor surgery for patients with BS. Methods: This retrospective study included patients who underwent brain tumor surgery between 2011 and 2015. BS was diagnosed based on the clinical signs of cerebrospinal fluid hypovolemia along with the radiological findings of the basal cistern effacement. Based on the data on the clinical features, the symptoms were used to determine the BS risk factors using logistic regression. Results: Overall, among the 412 patients included in this study, 12 (2.91%) were found to develop BS, 10 experienced altered consciousness, and 2 experienced orthostatic headaches. In all cases, radiological images at onset showed epidural/subdural fluid collection, along with basal cistern effacement. LD was inserted just before surgery in 11 cases, while a ventriculoperitoneal shunt was placed in one patient. The treatment strategies used are as follows: Ringer's solution infusion (n = 4), Trendelenburg position (n = 2), intrathecal injection of saline (n = 1), or no care due to misdiagnosis (n = 5). Moreover, the significant BS risk factors were determined to be the LD (odds ratio [OR] 30.70, CI 2.77-339.86), supratentorial skull base approach (SBA) (OR 35.71, CI 9.1922-138.7250), surgical time (1693.07, CI 69.5621-41207.448), and postoperative hyperosmotic diuretic use (OR 8.092, CI 2.485-26.345) after surgery. Conclusions: In the brain tumor surgery, aside from the LD, the application of supratentorial SBA, use of HD, and lengthy surgery are also found to be contributing risk factors for BS. Therefore, BS should be considered in the differential diagnosis of high-risk patients with postoperative altered consciousness.
Type: article
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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