Complications of Transcranial Craniofacial Surgery

　　　　　顱顏手術如須經顱進行，則其產生合併症的危險較一般手術來得高。在14年間，我們共有95位病人曾接受經顱顱顏手術，包含下列病症:先天性畸形有Apert氏症候群，Crouzon氏病，單純顱縫線封閉過早（craniosynostosis）。眼過距症（orbitalhypertelorism）；腫瘤有纖維性發育不良（fibrous dysplasia），神經纖維瘤病。肉瘤，癌瘤；及外傷性首次或後續重建。這些手術都需整形外科和神經外科醫師的團隊合作來完成，其產生的合併症從貧血、感染、腦脊髓液滲漏、癲癇，到最嚴重的死亡都有。總合併症發生率為33。而主要合併症發生率為24。經統計分析發現:腦硬膜撕裂與腦脊髓液滲漏有相關性（P<0.05）；發生合併症的手術其失血量較多（P<0.05），且手術時間較長（P<0.05）。我們同時發現，口腔內切口並不會增加產生合併症的危險，且手術時間長短與感染發生與否無關。其後我們探討一些主要合併症發生的原因，並提出數項降低合併症發生率的方法。
　　　　　Craniofacial surgery with a transcranial exposure carries a high risk of complications. Over a 14-year period, 95 patients were operated on transcranially with the following conditions: congenital anomalies (Apert's syndrome, Crouzon's disease, simple craniosynostosis, orbital hypertelorism), tumors (fibrous dysplasia, neurofibromatosis, sareoma, carcinoma) and trauma (primary or secondary reconstructions). These procedures involved the plastic surgery and neurosurgery teams in combination for surgical exposure and correction of complex craniofacial problems. The complications ranged from anemia, infection, CSF leakage, seizure, to the most serious one, death. The overall complication rate was 33%, and the major complication rate was 24%. In statistical analysis, the dura tear was correlated with CSF leaks (p<0.05). Blood loss was greater in procedures with complication (p<0.05), and operating time was longer in operations with complication (p<0.05). Intraoral incision did not increase the morbidity, and operating time was not correlated with infections. The causes of some major complications were investigated and the methods for reducing the complication rate were proposed.