Analysis Of Risk Factors For Postoperative Cerebrospinal Fluid Leak After Craniovertebral Junction Abnormalities Surgery

Objective:To investigate the risk factors of cerebrospinal fluid leak after craniovertebral junction abnormalities surgery,so as to provide a reference for clinical practice.Methods:The medical records of 77 patients who had elective craniovertebral junction abnormalities surgery during a six-year period(From April 2013 to September 2019)were reviewed.The information recorded for each patient included gender,age,disease course,anterior atlantodental interval(AADI),Chamberlain line(CL),basion-dental interval(BDI),basion-posterior axial line interval(BAI),assimilation of the atlas,cranial base angle(CBA),clivus-canal angle(CCA),cervical stenosis,cerebellar tonsillar herniation,syringomyelia,surgical approach,surgical segment and surgery duration.We performed single-factor analysis and logistic regression analysis on the above related factors.Results:9 cases occurred CSF leak,and the overall prevalence of cerebrospinal fluid leaks was 13.636%.Single-factor showed that craniovertebral junction instability(BDI>10 mm)and assimilation of the atlas had significant inter-group differences(p<0.05).Logistic regression analysis showed that CVJ instability(BDI>10mm)was an independent risk factor for cerebrospinal fluid leakage after craniovertebral junction abnormalities surgery,and patients with craniovertebral junction abnormalities who have CVJ instability(BDI>10mm)are 14.674 times more likely to have postoperative cerebrospinal fluid leak than patients without CVJ instability.(p<0.05).Conclusion:In patients with CVJ abnormalities,if BDI is more than 10 mm through preoperative imaging analysis,instability of CVJ should be considered.The preoperative CVJ instability(BDI>10 mm)is an independent risk factor for cerebrospinal fluid leak after CVJ abnormalities surgery,and the possibility of postoperative cerebrospinal fluid leak is significantly increased when CVJ abnormalities patients are combined with CVJ instability(BDI>10 mm).Therefore,for such patients,we should separate tissues more carefully and protect dura during operation.