Date Published: April 18, 2019
Publisher: Public Library of Science
Author(s): Zhenhua He, Huijuan Cheng, Haiyang Wu, Guodong Sun, Jingmin Yuan, Raffaele Serra.
This study is to identify the risk factors for postoperative delirium (PODE) in patients undergoing microvascular decompression (MVD) for the treatment of primary cranial nerve disorders. We retrospectively reviewed the data of 912 patients (354 men, 558 women) with primary cranial nerve disorders (trigeminal neuralgia, 602 patients; hemifacial spasm, 296 patients; glossopharyngeal neuralgia, 14 patients) who underwent MVD in the Neurosurgery Department of Lanzhou University Second Hospital between July 2007 and June 2018. Potential risk factors for PODE were identified using univariate and multivariate stepwise logistic regression analysis.Of the 912 patients, 221 (24.2%) patients developed PODE. Patients with PODE were significantly older and significantly more likely to be male than patients without PODE. A history of hypertension, preoperative carbamazepine therapy, and postoperative sleep disturbance and tension pneumocephalus were independently associated with PODE. Variables such as body-mass index, smoking and drinking habits, cardiac disease, diabetes mellitus, cerebrovascular disease, mean operative time, affected vessel, mean blood loss, postoperative intensive care unit stay, postoperative fever (>38°C), and routine laboratory results were not associated with PODE in our patients.PODE is a common complication after MVD, and is associated with multiple risk factors, including old age, male sex, hypertension, preoperative carbamazepine use, postoperative sleep disturbance, and tension pneumocephalus.
Microvascular decompression (MVD) is widely recognized as the neurosurgical treatment of choice for patients with primary cranial nerve disorders, including trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia, as well as various neurovascular compressions. However, delirium is a common complication after MVD surgery, with reported incidence rates of 14.9%–27.3% . This postoperative delirium (PODE) is an acute but transient organic brain syndrome characterized by inattention and altered levels of consciousness . The development of PODE after MVD procedures tends to prolong hospital stays and increase medical costs as well as morbidity and mortality . However, few studies have focused on PODE in patients undergoing MVD surgery [2, 5], and the exact pathogenesis of this complication remains poorly understood. A deeper understanding of the risk factors for PODE is required to identify at-risk patients as well as possible therapeutic interventions. Therefore, in this study, we aimed to identify the independent risk factors for PODE after MVD surgery in a large cohort of patients with primary cranial nerve disorders. We hope that our findings will indicate possible clinical interventions that might minimize the risk of PODE in this patient population.
The present study found that PODE is a common complication after MVD surgery for patients with primary cranial nerve disorders. Furthermore, the study identified multiple risk factors for this complication, including older age, male sex, a history of hypertension, postoperative sleep disturbance, postoperative tension pneumocephalus, and preoperative CBZ therapy. The incidence of PODE in our study was 24.2%, which is consistent with a previous report .
PODE is a common complication of MVD surgery among patients with primary cranial nerve disorders, occurring in nearly a quarter of our patients (24.2%). Old age, male sex, a history of hypertension, preoperative CBZ therapy (especially long-term high-dose therapy), postoperative sleep disturbance, and the Mount Fuji sign on postoperative brain CT scans were associated with developing PODE after MVD procedures. Patients with these risk factors should be closely monitored. In addition, the dosage of CBZ should be gradually lowered prior to surgery.