目的：研究鞍区肿瘤术后中枢神经系统感染(Postoperative Central Nervous System Infections, PCNSIs)的相关危险因素。

方法：我们对2016年1月至2019年11月期间，在北京协和医院接受手术治疗的所有鞍区肿瘤患者进行了回顾性分析。选取44例术后中枢神经系统感染患者，并设置年龄和性别相匹配的44例术后未感染患者作为对照组。对两组患者进行单因素和多因素分析以确定PCNSIs的危险因素。

结果：单因素分析研究发现手术入路(经颅手术) (P<0.001)、同一部位既往手术史(P=0.001)、术中脑脊液漏(P<0.001)、术后肾上腺功能不全(P=0.017)、术后尿崩 (P=0.004)、高钠血症(<0.001)与PCNSIs显著相关。多因素分析显示手术入路(经颅手术)(OR: 77.588；95%置信区间：7.981——754.263；P<0.001)，术中脑脊液漏(OR: 12.906；95%——35.723;P=0.019)和术后肾上腺功能不全 (OR: 6.115；95%置信区间：1.025——36.469；P=0.047)为PCNSIs的独立影响因素。

结论：经颅手术、术中脑脊液漏、术后尿崩、术后肾上腺功能不全是鞍区肿瘤患者发生PCNSIs的危险因素。

目的:探讨脑室腹腔分流术(Ventriculoperitoneal shunt，VPS)治疗隐球菌性脑膜炎(Cryptococcal Meningitis，CM)的短期和长期疗效。

方法:回顾性分析1990年9月至2021年1月北京协和医院收治的98例CM患者临床资料，其中15例接受了VPS。研究VPS治疗后的CM患者术后短期和长期预后结果。根据是否接受了分流手术，对全部CM患者进行分组，并对总生存期(Overall survival ，OS)进行log-rank检验，采用Kaplan-Meier法进行比较。使用Cox比例风险模型进行单变量和多变量分析，以确定具有统计学意义的预后因素。

结果:15例VPS患者术后脑脊液隐球菌负荷较低(1:1 vs 1:16;P=0.046)，具脑脊液压力下降(173.3 mmH₂0 vs 224 mmH20;P=0.009)，危重病例发生率降低(6.7% vs 31.3%;P = 0.049)。根据长期随访结果，发现两组之间的Barthel指数(Barthel Index，BI)无显著差异。VPS组里2例患者术后出现手术相关并发症，再次进行了翻修手术。生存分析显示，VPS组与Non-VPS组的总生存期无明显差异。然而，Kaplan-Meier图显示接受VPS手术的危重患者OS生存率更高(p < 0.009)。多变量分析显示VPS是危重患者良好预后的独立预测因素。

结论:VPS可降低CM患者颅内压(Intracranial pressure，ICP)，能较快地降低隐球菌负荷和减少危重病例数量。在危重症患者当中应用VPS能显著改善生存率。然而与保守治疗相比，VPS并不能改善患者的长期Barthel指数(BI)，并可能引起术后并发症。

Objective: The purpose of this study was to verify the risk factors for postoperative central nervous system infections (PCNSIs) of patients who underwent surgery for sellar region lesions.
Method: We performed a retrospective analysis of all patients with sellar region lesions who underwent surgery between January 2016 and November 2019 at Peking Union Medical College Hospital. In total, 44 patients with PCNSIs and 44 age−and sex-matched controls were enrolled. Univariate and multivariate analyses were performed to identify risk factors for PCNSIs.

Result: We found Surgical approach (TCS) (P<0.001), previous surgery on the same site (P=0.001), intraoperative cerebral spinal fluid (CSF) leakage (P<0.001), postoperative adrenal insufficiency (P=0.017), postoperative DI (P=0.004) and the maximum Na+ levels(<0.001) correlated significantly with PCNSIs. Multivariate analysis showed that Surgery approach (TCS)(OR: 77.588; 95%CI: 7.981-754.263; P<0.001), intraoperative CSF leakage (OR: 12.906; 95%CI: 3.499-47.602; P<0.001), postoperative DI (OR: 6.999; 95%CI:1.371-35.723; P=0.019) and postoperative adrenal insufficiency (OR: 6.115; 95%CI: 1.025-36.469; P=0.047) were independent influencing factors for PCNSIs.
Conclusion: TCS, intraoperative CSF leakage, postoperative DI and postoperative adrenal insufficiency are risk factors for PCNSIs in patients with sellar region tumors.

Objective: The purpose of this study was to assess the short-term, long-term outcomes of ventriculoperitoneal shunt (VPS) placement in cryptococcal meningitis (CM) patients.

Method: We performed a retrospective analysis of all patients with CM admitted to Peking Union Medical College Hospital from September 1990 to January 2021. We enrolled 98 patients, 15 of whom underwent VPS. All patients were grouped according to whether they underwent shunt surgery. We collected related clinical features to analysis the short and long-term outcomes of VPS at one month and one year at least following therapy, respectively. Overall survival (OS) was compared with all patients and subgroup of critical ill cases by the Kaplan-Meier method with log-rank test. Univariable and multivariable analyses were also performed using the Cox proportional hazard model to identify statistically significant prognostic factors.

Result: Those who received VPS had a lower CSF cryptococcus burden (1:1 vs 1:16; P=0.046), lower opening pressures (173.3 mmH20 vs 224 mmH20; P=0.009) at lumbar punctures and a lower incidence of critical cases (6.7% vs 31.3%; P=0.049). According to our long-term follow up, no significant difference shown in the Barthel Index (BI) between the two groups. Two patients in the VPS group suffered postoperative complications and had to go through another revision surgery. According to survival analysis, overall survival (OS) between VPS and Non-VPS groups was not significant different. However, the Kaplan-Meier plots showed that critical patients with VPS had better survival in OS (p < 0.009). Multivariable analyses for critical patients showed VPS was independent prognostic factors.

Conclusion: VPS could reduce the intracranial pressure (ICP), decrease the counts of Cryptococcus neoformans by a faster rate and reduce the number of critical cases.  VPS used in critical CM patients has a significant impact on survival, but it showed no improvement in the long-term Barthel Index (BI) versus conservative treatment and could lead to postoperative complications.