目的:尽管颅底重建原理的认识取得了重大进展,组织封闭剂在改善术后脑脊液(CSF)渗漏结局方面的作用仍存在争议.我们评估了内窥镜颅底手术(ESBS)期间颅底缺损修复中与组织密封剂使用相关的术后CSF泄漏发生率。
方法:WebofScience,PubMed/MEDLINE,Scopus,科克伦图书馆
方法:风险差异(RD)的系统评价和荟萃分析。搜索策略确定了报告ESBS后CSF泄漏的原始研究,并通过组织密封剂的使用和/或类型进行了解聚。
结果:27项非随机研究(n=2,403)纳入了定性和荟萃分析。与不使用密封剂的重建相比,使用组织密封剂的重建并没有显着降低术后CSF泄漏的风险(RD[95%CI]=0.02[-0.01,0.05])。与无密封剂相比,硬脑膜密封剂(-0.02[-0.11,0.07])和纤维蛋白胶(0.00[-0.07,0.07])的亚分析同样不显著。在DuraSeal的进一步子分析中,术后CSF泄漏没有显著调节(0.02[-0.02,0.05]),Adherus(-0.03[-0.08,0.03]),或生物胶(-0.06[-0.23,0.12])与不使用硬脑膜密封剂相比,或Tisseel/Tissucol与未使用纤维蛋白胶(0.00[-0.05,0.05])。在成对(0.01[-0.03,0.05])或网络荟萃分析(-0.01[-0.05,0.04])上,比较硬脑膜密封剂的使用与纤维蛋白胶的使用没有显着关联。来源文献的局限性阻止了按泄漏特征分层的子分析,缺陷的大小和位置,和相应的重建材料。
结论:与不使用组织密封剂相比,使用组织密封剂对术后脑脊液漏发生率没有影响。有必要进行更高质量的研究,以彻底阐明在内窥镜颅底重建中使用辅助密封剂的临床价值。
方法:N/A喉镜,134:3425-3436,2024.
OBJECTIVE: Despite significant advances in understanding of skull base reconstruction principles, the role of tissue sealants in modifying postoperative cerebrospinal fluid (CSF) leak outcomes remains controversial. We evaluate postoperative CSF leak incidence associated with tissue sealant use in skull base defect repair during endoscopic skull base surgery (ESBS).
METHODS: Web of Science, PubMed/MEDLINE, Scopus, and Cochrane Library.
METHODS: Systematic
review and meta-analysis of risk differences (RD). A search strategy identified original studies reporting CSF leakage following ESBS with disaggregation by tissue sealant use and/or type.
RESULTS: 27 non-randomized studies (n = 2,403) were included for qualitative and meta-analysis. Reconstruction with a tissue sealant did not significantly reduce postoperative CSF leak risk compared with reconstruction without sealant (RD[95% CI] = 0.02[-0.01, 0.05]). Sub-analyses of dural sealant (-0.02[-0.11, 0.07]) and fibrin glue (0.00[-0.07, 0.07]) compared with no sealant were similarly unremarkable. Postoperative CSF leakage was not significantly modulated in further sub-analyses of DuraSeal (0.02[-0.02, 0.05]), Adherus (-0.03[-0.08, 0.03]), or Bioglue (-0.06[-0.23, 0.12]) versus no dural sealant use, or Tisseel/Tissucol versus fibrin glue nonuse (0.00[-0.05, 0.05]). No significant association was seen comparing dural sealant use versus fibrin glue use on pairwise (0.01[-0.03, 0.05]) or network meta-analysis (-0.01[-0.05, 0.04]). Limitations in source literature prevented sub-analyses stratified by leak characteristics, defect size and location, and accompanying reconstruction materials.
CONCLUSIONS: Tissue sealant use did not appear to impact postoperative CSF leak incidence when compared with nonuse. Higher quality studies are warranted to thoroughly elucidate the clinical value of adjunct sealant use in endoscopic skull base reconstruction.
METHODS: N/A Laryngoscope, 134:3425-3436, 2024.