BACKGROUND For supratentorial craniotomy, surgical access, and closure technique, including placement of subgaleal drains, may vary considerably. The influence of surgical nuances on postoperative complications such as cerebrospinal fluid leakage or impaired wound healing overall remains largely unclear. With this study, we are reporting our experiences and the impact of our clinical routines on outcome in a prospectively collected data set. METHOD We prospectively observed 150 consecutive patients undergoing supratentorial craniotomy and recorded technical variables (type/length of incision, size of craniotomy, technique of dural and skin closure, type of dressing, and placement of subgaleal drains). Outcome variables (subgaleal hematoma/CSF collection, periorbital edema, impairment of wound healing, infection, and need for operative revision) were recorded at time of discharge and at late follow-up. RESULTS Early subgaleal fluid collection was observed in 36.7% (2.8% at the late follow-up), and impaired wound healing was recorded in 3.3% of all cases, with an overall need for operative revision of 6.7%. Neither usage of dural sealants, lack of watertight dural closure, and presence of subgaleal drains, nor type of skin closure or dressing influenced outcome. Curved incisions, larger craniotomy, and tumor size, however, were associated with an increase in early CSF or hematoma collection (p < 0.0001, p = 0.001, p < 0.01 resp.), and larger craniotomy size was associated with longer persistence of subgaleal fluid collections (p < 0.05). CONCLUSIONS Based on our setting, individual surgical nuances such as the type of dural closure and the use of subgaleal drains resulted in a comparable complication rate and outcome. Subgaleal fluid collections were frequently observed after supratentorial procedures, irrespective of the closing technique employed, and resolve spontaneously in the majority of cases without significant sequelae. Our results are limited due to the observational nature in our single-center study and need to be validated by supportive prospective randomized design.

中文翻译：

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幕上手术的手术细微差别和帽状膜下引流管的放置——对 150 次开颅手术的疗效和结果的前瞻性分析。

背景对于幕上开颅手术，手术通路和闭合技术，包括帽状腱膜下引流管的放置，可能会有很大差异。手术细微差别对术后并发症（如脑脊液漏或伤口愈合受损）的影响在很大程度上仍不清楚。通过这项研究，我们将在前瞻性收集的数据集中报告我们的经验以及我们的临床常规对结果的影响。方法 我们前瞻性地观察了 150 名接受幕上开颅手术的连续患者，并记录了技术变量（切口类型/长度、开颅手术的大小、硬脑膜和皮肤闭合技术、敷料类型和帽状腱膜下引流管的放置）。结果变量（帽状疱疹下血肿/CSF 收集、眶周水肿、伤口愈合受损、感染、和需要手术翻修）在出院时和后期随访时记录。结果 36.7%（后期随访时为 2.8%）观察到早期帽状液收集，所有病例中 3.3% 的伤口愈合受损，6.7% 的总体需要手术翻修。硬脑膜密封剂的使用、硬脑膜封闭不严密、帽状腱膜下引流管的存在、皮肤封闭或敷料的类型均不影响结果。然而，弯曲的切口、较大的开颅手术和肿瘤大小与早期脑脊液或血肿收集的增加有关（p < 0.0001，p = 0.001，p < 0.01 分别），并且较大的开颅手术尺寸与帽状腱膜下持续时间更长有关液体收集（p < 0.05）。结论 根据我们的设置，个体手术的细微差别，例如硬脑膜闭合的类型和帽状疱疹下引流管的使用，导致了相当的并发症发生率和结果。无论采用何种闭合技术，幕上手术后都经常观察到帽状疱疹下积液，并且在大多数情况下会自发消退，没有明显的后遗症。由于我们的单中心研究的观察性质，我们的结果有限，需要通过支持性前瞻性随机设计进行验证。