虽然脑室腹腔分流术(VPS)插入是脊髓膜膨出相关性脑积水(MAH)的标准治疗方法,感染和分流故障会使其复杂化。因此,内镜下第三脑室造瘘术(ETV),有或没有脉络丛凝固(CPC),已被提议作为替代方案。这次审查的目的是确定成功,技术故障,MAH患者有或没有CPC的ETV并发症发生率。
PubMed,Scopus,从开始到2020年6月,对Cochrane中央对照试验登记册数据库进行了搜索,以获取病例系列,队列研究,或报告成功的随机对照试验,技术故障,或并发症发生率。进行随机效应分析以确定这些结果测量的估计值。使用纽卡斯尔-渥太华量表评估研究的质量和偏倚风险。
共有325名接受ETV或ETV+CPC的患者的13项研究纳入了该综述。使用随机效果建模,成功率的汇总估计为56%(95%CI44%-68%,I2=78%),而技术故障率为2%(95%CI0%-6%,I2=32%)。对成功率的估计具有很高的异质性,由于手术干预的类型(ETVvsETV+CPC,p<0.001)。对9项研究进行随机效应分析,其中117例患者仅接受ETV,估计成功率为48%(95%CI0.39-0.57,I2=0%),而对166例接受ETV+CPC的患者进行的4项研究的分析显示成功率为75%(95%CI67%-82%,I2=21%)。对轻度/中度的估计,严重,致命并发症发生率为0(95%CI0%-4%,I2=0%),2%(95%CI0%-10%,I2=52%),和0(95%CI0%-1%,I2=0%),分别。
在已发表研究的荟萃分析中,ETV+CPC对MAH的成功率高于单独ETV。ETV,有或没有CPC,在技术上是可行的和安全的患者群体。
While ventriculoperitoneal shunt (VPS) insertion is the standard treatment for
myelomeningocele-associated hydrocephalus (MAH), it can be complicated by infection and shunt malfunction. As such, endoscopic third ventriculostomy (ETV), with or without choroid plexus coagulation (CPC), has been proposed as an alternative. The aim of this
review was to determine the success, technical failure, and complication rates of ETV with or without CPC in patients with MAH.
PubMed, Scopus, and Cochrane Central Register of Controlled Trials databases were searched from inception to June 2020 for case series, cohort studies, or randomized controlled trials reporting success, technical failure, or complication rates. Random-effects analysis was performed to determine the estimates for these outcome measures. Studies were evaluated using the Newcastle-Ottawa Scale for quality and risk of bias.
Thirteen studies with a total of 325 patients who underwent either ETV or ETV+CPC were included in the
review. Using random-effects modeling, the pooled estimate of the success rate was 56% (95% CI 44%-68%, I2 = 78%), while the technical failure rate was 2% (95% CI 0%-6%, I2 = 32%). The estimate for the success rate had high heterogeneity, due to the type of surgical intervention (ETV vs ETV+CPC, p < 0.001). Random-effects analysis of 9 studies with 117 patients who underwent ETV alone yielded an estimated success rate of 48% (95% CI 0.39-0.57, I2 = 0%), while analysis of 4 studies with 166 patients who underwent ETV+CPC revealed a success rate of 75% (95% CI 67%-82%, I2 = 21%). The estimates for the mild/moderate, severe, and fatal complication rates were 0 (95% CI 0%-4%, I2 = 0%), 2% (95% CI 0%-10%, I2 = 52%), and 0 (95% CI 0%-1%, I2 = 0%), respectively.
ETV+CPC was associated with a higher success rate than ETV alone for MAH in a meta-analysis of published studies. ETV, with or without CPC, was technically feasible and safe for this patient population.