背景:由于它们精致而根深蒂固的位置,大脑松果体区的肿瘤在神经外科治疗中面临着巨大的挑战。高度精确的程序已成为解决这些复杂性的关键,如同时进行活检和内镜下第三脑室造瘘术(ETV)。我们的目的是评估可行性,安全,同时活检和ETV治疗松果体区肿瘤患者的疗效。
方法:Medline,Embase,根据Cochrane和PRISMA指南,从2000年1月到2024年2月,搜索了WebofScience的英语研究。合格的研究包括至少四名患者,并检查了以下至少一项结果:良好的临床结果和分流放置的必要性。在随机效应模型下进行95%置信区间的单比例分析,采用I2统计量评估异质性。此外,使用ROBINS-I工具评估发表偏倚.
结果:经过细致的选择过程,分析中纳入了18项涉及390名患者的研究。总的来说,在147例患者中,有131例观察到良好的临床结果,代表92%的比率(95%CI:84%至100%,I2=62%)通过随机效应分析。亚组分析显示,儿童表现出非常高的良好临床结局率,达到100%(95%CI:96%至100%,I2=0%)。关于分流器放置的需要,在评估的356名患者中,只有39个需要分流器放置,收益率为8%(95%CI:4%至12%,I2=63%)。进一步的子分析表明,儿童的分流需求率为12%,成人为3%。特别关注成年人,来自46例接受活检的患者的数据显示成功率为84%(95%CI:62%至100%,I2=81%)。值得注意的是,成人中没有重大并发症的报道,导致0%的比率(95%CI:0%至6%,I2=0%)。此外,在成年人中观察到与手术相关的低死亡率,在分析的46名患者中记录了两人死亡,导致死亡率为1%(95%CI:0%至7%,I2=0%)。
结论:结论:我们的研究旨在评估可行性,安全,以及对松果体区肿瘤患者同时进行活检和ETV的疗效。我们精心检查了临床方面和患者结果,包括良好的临床结果,ETV后分流器放置的要求,活检成功率,死亡率,和并发症。
BACKGROUND: Due to their delicate and deep-seated location, tumors in the pineal region of the brain pose exceptional challenges in neurosurgical management. Highly precise procedures have become crucial to address these complexities, such as the simultaneous performance of biopsy and endoscopic third ventriculostomy (ETV). Our aim was to assess the feasibility, safety, and efficacy of simultaneous biopsy and ETV for treating patients with pineal region tumors.
METHODS: Medline, Embase, and Web of Science were searched for English studies from January 2000 to February 2024, following Cochrane and PRISMA guidelines. Eligible studies encompassed a minimum of four patients and examined at least one of the following outcomes: good clinical outcomes and the necessity of shunt placement. Single proportion analysis with 95% confidence intervals was conducted under a random-effects model, employing the I2 statistic to assess heterogeneity. Additionally, publication bias was evaluated using the ROBINS-I tool.
RESULTS: After a meticulous selection process, eighteen studies involving 390 patients were included in the analysis. Overall, good clinical outcomes were observed in 131 out of 147 patients, representing a rate of 92 % (95 % CI: 84 % to 100 %, I2 = 62 %) through random effects analysis. Subgroup analysis showed that children exhibited a notably high rate of good clinical outcomes, reaching 100 % (95 % CI: 96 % to 100 %, I2 = 0 %). Regarding the need for shunt placement, out of the 356 patients assessed, only 39 required shunt placement, yielding a rate of 8 % (95 % CI: 4 % to 12 %, I2 = 63 %). Further sub-analyses indicated shunt requirement rates of 12 % for children and 3 % for adults. Specifically focusing on adults, data from 46 patients who underwent biopsy revealed a success rate of 84 % (95 % CI: 62 % to 100 %, I2 = 81 %). Remarkably, no major complications were reported among adults, resulting in a rate of 0 % (95 % CI: 0 % to 6 %, I2 = 0 %). Additionally, low rates of mortality related to the procedure were observed in adults, with two deaths recorded among the 46 patients analyzed, resulting in a mortality rate of 1 % (95 % CI: 0 % to 7 %, I2 = 0 %).
CONCLUSIONS: In conclusion, our study aimed to assess the feasibility, safety, and efficacy of performing simultaneous biopsy and ETV for patients with pineal region tumors. We meticulously examined clinical aspects and patient outcomes, including good clinical outcomes, the requirement for shunt placement after ETV, biopsy success rates, mortality, and complications.