Wound Healing After A Meningioma Resection: Risky And Dangerous Clinical Findings
Overview
The study aimed to assess the risk factors impacting wound healing and infection subsequent to spinal meningioma resection surgery. A thorough analysis was conducted on the surgical incision healing of 137 patients who underwent such procedures at our institution between January 2021 and January 2024. Data encompassing physical examination results, hematological and biochemical measurements, as well as various scales evaluated pre- and post-surgery, were meticulously gathered and scrutinized. Statistical analyses were performed to examine surgical wound healing, infection rates, and postoperative complications. Utilizing multiple logistic regression analysis, risk factor assessment was conducted on relevant indicators, calculating odds ratios and p-values at a 95% confidence interval.
The findings revealed significant correlations between several factors and wound healing and infection outcomes. Notably, age and smoking history exhibited negative correlations with wound healing, while preoperative albumin and platelet counts displayed positive correlations. Similarly, age, WHO Meningioma Grading, preoperative albumin, and platelet levels were negatively correlated with wound infection, while a history of virus infection and neurological disorders showed positive correlations. It’s imperative to note that each factor exerted a distinct influence on these outcomes.
In conclusion, factors such as age, smoking history, WHO Meningioma Grading, preoperative albumin and platelet levels, as well as a history of virus infection and neurological disorders, emerged as significant influencers on wound healing and infection following meningioma resection. These findings underscore the importance of comprehensive risk assessment and tailored interventions to optimize surgical outcomes in patients undergoing spinal meningioma resection surgery.
Introduction
Meningiomas arise from the malignant transformation of meningeal cells in the arachnoid or pia mater, characterized by slow growth and typically localized presentation. While most are benign, a minority exhibit malignancy. Spinal meningiomas, a common subtype, primarily manifest as intradural, extramedullary tumors, constituting a significant portion of spinal neoplasms. They predominantly affect middle-aged to elderly individuals, with a higher incidence among women.
Early symptoms may be subtle, progressing to manifest spinal cord compression symptoms such as pain, limb weakness, and urinary or fecal dysfunction. In cases of intracranial invasion, symptoms like severe headache and blurred vision may occur. Timely surgical intervention is crucial to mitigate risks of paralysis and dysfunction, with prognosis generally favorable post-resection. Surgical techniques vary based on tumor location, with approaches tailored to minimize spinal cord manipulation.
Postoperative care is paramount, emphasizing meticulous wound management to prevent infection and optimize healing. Various studies have explored innovative surgical approaches and postoperative protocols to enhance patient outcomes. A recent analysis of postoperative meningioma cases aimed to provide insights into optimizing incision healing and infection prevention, contributing to ongoing advancements in postoperative care practices.
Method
In a meticulous retrospective analysis conducted over a three-year period from January 2021 to January 2024, researchers delved into the medical records of 137 patients who underwent surgical resection for meningioma at our hospital. The primary objective was to uncover the intricate web of factors that impact the healing process following such surgical interventions. This investigation was conducted with the full approval of the hospital Ethics Committee, ensuring adherence to ethical standards, and the informed consent of each patient was diligently obtained, respecting their autonomy and rights.
A comprehensive array of data points was meticulously gathered and scrutinized, encompassing a diverse spectrum of variables that could potentially influence postoperative recovery. These variables spanned a broad range, including demographic factors such as age and gender, clinical parameters like hospitalization duration and postoperative follow-up frequency, and intricate medical histories encompassing virus infections (including HIV, HPV, and hepatitis B), usage of estrogen-related medications (such as oral contraceptives and hormone replacement therapy), and previous exposure to head imaging techniques and radiotherapy.
Furthermore, lifestyle factors such as smoking and alcohol consumption were carefully recorded, alongside pertinent medical histories like previous traumatic brain injuries, familial predispositions to meningioma, and existing neurological disorders. Moreover, detailed hematological indicators including preoperative albumin levels, platelet counts, and postoperative white blood cell counts were meticulously documented and subjected to rigorous analysis.
Patients were stratified into distinct groups based on gender and the stage of wound healing post-meningioma resection. This staging system, delineating primary, secondary, and tertiary wound healing, provided a nuanced framework for understanding the intricacies of wound recovery. Primary healing denotes the swift closure of minor wounds without infection, while secondary healing encompasses larger wounds with irregular margins or potential infectious complications. Tertiary healing, characterized by the formation of a protective scab, entails a prolonged healing process beneath its shelter.
This study endeavors to shed light on the multifaceted determinants of postoperative wound healing in meningioma patients, with the ultimate goal of enhancing clinical management strategies and optimizing patient outcomes through a more nuanced understanding of these complex dynamics. By unraveling the intricate interplay of various factors, this research aspires to pave the way for tailored interventions that promote expedited and complication-free recovery, thereby augmenting the quality of care delivered to meningioma patients.
Statistical Analysis
The study focused on analyzing patient data pertaining to meningioma, encompassing various factors such as age, gender, medical history, and hematological indicators both before and after surgery. Continuity variables were presented using mean values with standard deviations, while differences between groups were assessed using t-tests. Categorical variables were represented by counts and percentages, with the significance of group differences evaluated through chi-square tests. A significance level of p < 0.05 indicated notable differences between groups. IBM SPSS Statistics 25 software facilitated multiple logistic regression analysis to identify risk factors impacting postoperative wound healing. Factors with a p-value < 0.05 and odds ratios within a 95% confidence interval were deemed significant in influencing wound healing. Notably, the study categorized wound healing into stages, with the second and third stages considered indicative of poor healing due to the potential for infection-related delays. Consequently, first-stage wound healing was categorized as indicative of good healing in the analysis.
Result
The study involved an extensive analysis of 137 patients diagnosed with meningioma, a type of brain tumor. Researchers meticulously examined various factors to better understand the outcomes of meningioma resection surgeries, particularly focusing on wound healing and infection rates. Here’s a more detailed breakdown of the study’s key components:
- Gender Distribution and Comparative Analysis: Researchers initially looked at the gender distribution among the patient cohort and compared it across different groups. They utilized statistical tools like the Chi-square test and t-test to evaluate the significance of differences in various indicators between male and female patients. Notable findings included significant differences in preoperative platelet count, postoperative white blood cell count, and smoking history among genders.
- Comparison of Wound Healing Status: After meningioma resection surgeries, the study categorized patients based on their wound healing status into different groups. Subsequent analysis involved comparing various parameters among these groups. Significant disparities were observed in indicators such as age, hospitalization time, and medical histories like virus infection and estrogen use. These findings underscored the multifactorial nature of wound healing outcomes.
- Multiple Logistic Regression Analysis of Wound Healing: To delve deeper into factors influencing wound healing, researchers employed multiple logistic regression analysis. This advanced statistical technique allowed them to identify significant correlates of wound healing post-surgery. Factors such as age, WHO Meningioma Grading, and certain medical histories emerged as influential variables. Notably, preoperative albumin levels and platelet count were positively correlated with improved wound healing outcomes, while age was identified as a significant risk factor.
- Multiple Logistic Regression Analysis of Wound Infection: In a similar fashion, the study also investigated factors contributing to postoperative wound infections using multiple logistic regression analysis. Significant predictors of wound infection included age, postoperative follow-up frequency, and various medical histories. Interestingly, preoperative albumin levels and platelet count were associated with an increased risk of postoperative wound infection, highlighting their complex role in surgical outcomes.
Overall, the study’s comprehensive analyses shed light on the intricate interplay of factors influencing both wound healing and infection following meningioma resection surgeries. These findings carry significant implications for clinical practice, informing strategies to optimize surgical outcomes and reduce the risk of complications for meningioma patients undergoing surgery.
In a second study involving 291 patients (median age 60 years old, 71.5% female, average follow-up of 36 months) who underwent meningioma resection, no cases of wound infection or death were reported, and wounds healed adequately. This indicates that small wounds tend to heal effectively, aligning with the findings of the study. However, the patient’s overall health and surgical trauma can influence wound healing after meningioma surgery, while postoperative complications can also impact the process.
A meta-analysis by Lasunin et al. emphasized the importance of reconstructing the orbital wall after meningioma surgery to correct eye positioning. Complications such as wound infection and cerebrospinal fluid leakage were observed postoperatively, albeit with no significant variance among different subgroups. Various factors during meningioma resection may hinder wound closure in the short term, as highlighted by Shen et al.’s study on acute cerebral venous outflow obstruction during convex meningioma resection.
Kwee et al.’s evaluation of postoperative outcomes in patients with spinal meningioma underscored the significance of postoperative complications, including cerebrospinal fluid leakage and wound healing issues, in determining overall prognosis.
Recent research has delved into the mechanisms and signaling pathways involved in wound healing. Zhang et al. elucidated the role of M2 in wound healing, discovering its promotion of wound healing by secreting CTGF, which further mediates fibroblast proliferation and migration through various pathways. Lan et al.’s study on the DsrNA-induced IFN-β-MMP13 axis highlighted the complex dynamics of corneal wound healing and the impact of RNA-related mechanisms on the process.
However, the study acknowledges certain limitations, including reliance on data from electronic medical records in a single hospital and incomplete patient data. Future research aims to address these limitations by including pre-hospitalization data and collaborating with other hospitals to enhance the research database. Additionally, efforts will be made to expand the range of patient indicators for a more comprehensive analysis of wound recovery after meningioma surgery, with the goal of providing valuable insights for postoperative recovery and well-being.
Conclusion
Meningiomas are tumors that originate from the arachnoid endothelial cells or fibrocytes of the dura, which is a dense connective tissue forming a protective layer around the brain and spinal cord. Surgical removal of meningiomas involves incisions typically ranging from 3 to 4 cm, but may extend beyond 10 cm for extensive tumors. Postoperative care is crucial, with factors such as age, smoking history, preoperative albumin, platelet count, and presence of certain medical conditions significantly affecting wound healing and infection rates.
Studies have shown that wound complications, including infections, are common after meningioma surgery, emphasizing the importance of meticulous postoperative care. Radiation therapy, multiple imaging scans, and certain patient characteristics such as age can impact wound healing outcomes. Additionally, steroid therapy before surgery may increase the risk of postoperative complications.
Various approaches to wound treatment, including muscle flap resection, skin grafting, debridement, antibiotics, and negative pressure wound therapy, have been employed to facilitate healing following meningioma surgery. It’s essential to tailor treatment strategies to individual patient needs to optimize outcomes.
Research comparing outcomes between elderly and younger patients undergoing meningioma surgery highlights differences in wound healing and complication rates, underscoring the importance of considering age-related factors in treatment planning. Minimally invasive surgical techniques may offer advantages for certain patient populations, warranting further investigation and comparison.
Various elements impact wound healing and infection following meningioma resection, each exerting a distinct influence. Key factors such as age, smoking habits, WHO Meningioma Grading, preoperative albumin levels, preoperative platelet counts, history of viral infections, and neurological disorders significantly affect postoperative outcomes. Understanding the significance of these factors is crucial for optimizing the postoperative recovery of meningioma patients. Our study contributes valuable insights to inform clinical treatment strategies in this regard.
In conclusion, understanding the factors influencing wound healing and infection after meningioma surgery is crucial for implementing effective postoperative care strategies and optimizing patient outcomes. Further research is needed to refine treatment approaches and improve surgical outcomes for patients with meningiomas.
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