We performed a comprehensive literature search to identify articles reporting data on VST after PCF/CPA surgery. We selected only comparative studies providing adequate neuroimaging assessing VST and a control group.
We included 13 articles reporting 1855 patients. VST occurred in 251/1855 cases (estimated incidence, 17.3%; 95% confidence interval [CI], 12.4%-22.2%). Only presigmoid approach (odds ratio [OR], 2.505; 95% CI, 1.161-5.404; P = 0.019) and intraoperative sinus injury (OR, 8.95; 95% CI, 3.43-23.34; P < 0.001) showed a significant association with VST. VST-related symptoms were reported in 12/251 patients with VST (pooled incidence, 3.1%; 95% CI, 1%-5.2%). In particular, we found a significantly increased OR of cerebrospinal fluid leak (OR, 3.197; 95% CI, 1.899-5.382; P < 0.001) and cerebrospinal fluid dynamic alterations in general (OR, 3.625; 95% CI, 2.370-5.543; P < 0.001). Indications for VST treatment were heterogeneous: 58/251 patients underwent antithrombotics, with 6 treatment-related bleedings. Recanalization overall occurred in 56.4% (95% CI, 40.6%-72.2%), with no significant difference between treated and untreated patients. However, untreated patients had a favorable outcome.
VST is a relatively frequent complication after PCF/CPA surgery and a presigmoid approach and intraoperative sinus injury represent the most significant risk factors. However, the clinical course is generally benign, with no advantage of antithrombotic therapy.
方法:我们进行了全面的文献检索,以确定PCF/CPA手术后VST的手稿报告数据。我们仅选择了提供足够的神经影像学评估VST和对照组的比较研究。
结果:我们纳入了报告1855例患者的13篇论文。251/1855例发生VST(估计发生率:17.3%;95CI:12.4%-22.2%)。只有乙状窦入路(OR2.505;95CI:1.161-5.404;p=0.019)和术中窦损伤(OR8.95;95CI:3.43-23.34;p<.001)与VST有显著相关性。在12/251例VST患者中报告了VST相关症状(合并发生率:3.1%;95CI:1%-5.2%)。特别是,我们发现,脑脊液漏出的OR显著增加(OR3.197;95CI:1.899-5.382;p<.001),脑脊液动态改变总体上显著增加(OR3.625;95CI:2.370-5.543;p<.001).VST治疗的适应症是异质性的:58/251例患者接受了抗血栓药物治疗,与6治疗相关的出血。在56.4%(CI95%:40.6%-72.2%)的患者中,在治疗和未治疗的患者之间没有显著差异。然而,未经治疗的患者有一个良好的结果。
结论:VST是PCF/CPA手术后相对常见的并发症,乙状窦入路和术中窦道损伤是最重要的危险因素。然而,临床过程通常是良性的,抗血栓治疗没有优势。