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

Motegi, Hiroaki; Yamaguchi, Shigeru; Okamoto, Michinari; Ishi, Yukitomo; Endo, Shogo; Kaneko, Sadahiro; Kobayashi, Hiroyuki; Terasaka, Shunsuke; Houkin, Kiyohiro

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

Motegi, Hiroaki; Yamaguchi, Shigeru; Okamoto, Michinari et al.

Interdisciplinary Neurosurgery-advanced Techniques And Case Management, 2021, 23, 100951

Permalink : https://hdl.handle.net/2115/80432

このアイテムのアクセス数:693件（2026-08-13 12:59 集計）

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https://doi.org/10.1016/j.inat.2020.100951			12

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アクセス権	open access
URI	https://hdl.handle.net/2115/80432
タイトル	Novel risk factors and management of brain sag after brain tumor surgery
著者	Motegi, Hiroaki ; Yamaguchi, Shigeru ; Okamoto, Michinari ; Ishi, Yukitomo ; Endo, Shogo ; Kaneko, Sadahiro ; Kobayashi, Hiroyuki ; Terasaka, Shunsuke ; Houkin, Kiyohiro
e-Rad_Researcher 40748844 著者名 Motegi, Hiroaki
著者名 Yamaguchi, Shigeru
著者名 Okamoto, Michinari
e-Rad_Researcher 30812284 著者名 Ishi, Yukitomo
著者名 Endo, Shogo
著者名 Kaneko, Sadahiro
e-Rad_Researcher 70374478 著者名 Kobayashi, Hiroyuki
e-Rad_Researcher 10447055 著者名 Terasaka, Shunsuke
e-Rad_Researcher 90229146 著者名 Houkin, Kiyohiro
言語	英語
キーワード	Intracranial hypotension
	Brain tumor
	Cerebrospinal fluid
	Lumber drain
	Skull base
	Risk factor
	Brain sag
発行日	2021-03
出版者	Elsevier
収録物名	Interdisciplinary Neurosurgery-advanced Techniques And Case Management
巻(号)	23
ページ	100951
抄録	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.
資源タイプ	学術雑誌論文
出版タイプ	Version of Record
権利情報	Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
関連情報 (isIdenticalTo)	出版社版DOI https://doi.org/10.1016/j.inat.2020.100951