파열성 또는 비파열성 뇌동맥류 수술을 위한 전측두 두개골 절제술에서 수술 부위 폐쇄적 흡입 배액관 삽입의 유용성

Abstract

Background: Cerebral aneurysm is one of the most common cerebrovascular disorders encountered by neurovascular surgeons. Fronto-temporal(pterional) craniotomy, designed and popularized by Yasargil in the 1970s, is the most commonly used approach for cerebral aneurysm surgery. During the last decades, surgical closed suction drains are widely used in various surgical specialties to reduce complications caused by postoperative fluid collection. However, only a scarce literature investigated the efficacy of surgical site suction drain in fronto-temporal(pterional) craniotomy for treating cerebral aneurysm. Methods: We performed a retrospective review of fronto-temporal(pterional) craniotomies for ruptured or unruptured cerebral aneurysm at our center between January 2006 and December 2020. We obtained data on the presence of surgical closed suction drain, the occurrence of epidural hematoma (EDH) requiring evacuation, and the occurrence of surgical site infection (SSI). We performed univariate and multivariate logistic regression analyses to determine the risk factors associated with EDH requiring evacuation and SSI, including the use of suction drain. Results: A total of 5,287 fronto-temporal(pterional) craniotomies in 5,147 patients performed. Subgaleal suction drain was inserted for 1,613 craniotomies in 1,597 patients. Suction drain was not inserted for 3,674 craniotomies in 3,550 patients. The presence of ruptured aneurysm and duration of operation were associated with EDH requiring evacuation (P < 0.001, P < 0.001, respectively). The presence of ruptured aneurysm was associated with SSI (P < 0.001). However, the presence of surgical suction drain was not associated with the occurrence of EDH requiring evacuation or SSI (P = 0.918, P = 0.406, respectively). Conclusion: Our study found that the use of surgical site suction drains does not affect the occurrence of EDH requiring evacuation or SSI. Thus, the routine use of surgical site suction drain for pterional craniotomy in cerebral aneurysm operation is not recommended.