Abstract：
OBJECTIVE: To compare the outcomes of different surgical approaches to petrous apex cholesterol granulomas (PACG).
METHODS: PubMed, Embase, Google Scholar, Cochrane, and Web of Science.
METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses-Network Meta-analyses guidelines, databases were searched from inception to November 31, 2022. Studies comparing two or more approaches were included. Reviews and population studies were excluded. The main outcome measures were the resolution of symptoms, serviceable hearing, complication, and revision rates.
RESULTS: The search yielded 2132 studies. After applying inclusion and exclusion criteria, 15 studies remained, consisting of 214 patients treated with lateral approaches (n = 182) or anterior endonasal approaches (n = 32). The efficacy of lateral and anterior endonasal approaches in achieving symptom resolution was comparable (73% vs. 68%, p = 0.5). Both exhibited similar rates of complications (33% vs. 37%, p = 0.3), albeit with distinct profiles. Lateral approaches were associated with higher rates of facial palsy and sensorineural hearing loss (44% vs. 18%, p = 0.03). Anterior endonasal approaches demonstrated higher rates of epistaxis and cerebrospinal fluid leak (15% vs. 1%, p = 0.001). Anterior endonasal approaches exhibited lower revision rates (OR: 0.35, 95% CI: 0.14-0.88). The placement of a stent in both approaches was associated with higher symptom resolution (OR: 5.12, 95% CI: 1.05-9.97) and lower revision rates (OR: 0.71, 95% CI: 0.33-0.92).
CONCLUSIONS: Anterior endonasal approaches yield lower revision rates compared to lateral approaches for PACG. Both approaches demonstrate similar effectiveness in symptom resolution and comparable rates of complications, with distinct profiles. Facial nerve and hearing status are important factors that should be addressed when selecting the approach. Stenting is beneficial.
METHODS: NA Laryngoscope, 134:1540-1550, 2024.
METHODS: PubMed, Embase, Google Scholar, Cochrane, and Web of Science.
METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses-Network Meta-analyses guidelines, databases were searched from inception to November 31, 2022. Studies comparing two or more approaches were included. Reviews and population studies were excluded. The main outcome measures were the resolution of symptoms, serviceable hearing, complication, and revision rates.
RESULTS: The search yielded 2132 studies. After applying inclusion and exclusion criteria, 15 studies remained, consisting of 214 patients treated with lateral approaches (n = 182) or anterior endonasal approaches (n = 32). The efficacy of lateral and anterior endonasal approaches in achieving symptom resolution was comparable (73% vs. 68%, p = 0.5). Both exhibited similar rates of complications (33% vs. 37%, p = 0.3), albeit with distinct profiles. Lateral approaches were associated with higher rates of facial palsy and sensorineural hearing loss (44% vs. 18%, p = 0.03). Anterior endonasal approaches demonstrated higher rates of epistaxis and cerebrospinal fluid leak (15% vs. 1%, p = 0.001). Anterior endonasal approaches exhibited lower revision rates (OR: 0.35, 95% CI: 0.14-0.88). The placement of a stent in both approaches was associated with higher symptom resolution (OR: 5.12, 95% CI: 1.05-9.97) and lower revision rates (OR: 0.71, 95% CI: 0.33-0.92).
CONCLUSIONS: Anterior endonasal approaches yield lower revision rates compared to lateral approaches for PACG. Both approaches demonstrate similar effectiveness in symptom resolution and comparable rates of complications, with distinct profiles. Facial nerve and hearing status are important factors that should be addressed when selecting the approach. Stenting is beneficial.
METHODS: NA Laryngoscope, 134:1540-1550, 2024.
摘要：
目的：比较不同手术方式治疗岩尖胆固醇肉芽肿（PACG）的疗效。
方法：PubMed，Embase,谷歌学者，科克伦,和WebofScience。
方法：遵循系统评价和荟萃分析的首选报告项目-网络荟萃分析指南，从开始到2022年11月31日搜索数据库。包括比较两种或两种以上方法的研究。排除了评论和人群研究。主要结果指标是症状的缓解，有用的听证会，并发症,和修订率。
结果：搜索产生了2132项研究。在应用纳入和排除标准后，还有15项研究，由214例患者的外侧入路（n=182）或鼻前入路（n=32）治疗。鼻侧和鼻前入路在实现症状缓解方面的疗效相当(73%与68%,p=0.5)。两者的并发症发生率相似(33%vs.37%,p=0.3),尽管有不同的轮廓。侧向入路与较高的面神经麻痹和感音神经性听力损失相关(44%vs.18%,p=0.03)。鼻前入路显示出较高的鼻出血和脑脊液漏发生率（15％vs.1%,p=0.001)。鼻前入路的翻修率较低（OR：0.35，95％CI：0.14-0.88）。在两种方法中放置支架与较高的症状分辨率（OR：5.12，95％CI：1.05-9.97）和较低的翻修率（OR：0.71，95％CI：0.33-0.92）相关。
结论：前鼻内入路与外侧入路相比，PACG的翻修率更低。两种方法在症状缓解和并发症发生率方面表现出相似的有效性。具有不同的轮廓。面神经和听力状态是选择方法时应注意的重要因素。固定是有益的。
方法：N/A喉镜，2023年。
方法：PubMed，Embase,谷歌学者，科克伦,和WebofScience。
方法：遵循系统评价和荟萃分析的首选报告项目-网络荟萃分析指南，从开始到2022年11月31日搜索数据库。包括比较两种或两种以上方法的研究。排除了评论和人群研究。主要结果指标是症状的缓解，有用的听证会，并发症,和修订率。
结果：搜索产生了2132项研究。在应用纳入和排除标准后，还有15项研究，由214例患者的外侧入路（n=182）或鼻前入路（n=32）治疗。鼻侧和鼻前入路在实现症状缓解方面的疗效相当(73%与68%,p=0.5)。两者的并发症发生率相似(33%vs.37%,p=0.3),尽管有不同的轮廓。侧向入路与较高的面神经麻痹和感音神经性听力损失相关(44%vs.18%,p=0.03)。鼻前入路显示出较高的鼻出血和脑脊液漏发生率（15％vs.1%,p=0.001)。鼻前入路的翻修率较低（OR：0.35，95％CI：0.14-0.88）。在两种方法中放置支架与较高的症状分辨率（OR：5.12，95％CI：1.05-9.97）和较低的翻修率（OR：0.71，95％CI：0.33-0.92）相关。
结论：前鼻内入路与外侧入路相比，PACG的翻修率更低。两种方法在症状缓解和并发症发生率方面表现出相似的有效性。具有不同的轮廓。面神经和听力状态是选择方法时应注意的重要因素。固定是有益的。
方法：N/A喉镜，2023年。
