Surgical Outcomes Comparison of Spontaneous Middle Cranial Fossa Cerebrospinal Fluid Leaks: Systematic Review and Meta-analysis.

IF 2.6 3区医学 Q1 OTORHINOLARYNGOLOGY

Otolaryngology- Head and Neck Surgery Pub Date : 2025-04-29 DOI:10.1002/ohn.1279

Dimitrios Spinos, Panagiotis Varoutis, Georgios Geropoulos, Georgios Vavoulis, Georgios Georgountzos, Nina Rafailia Karela, Manthia Papageorgakopoulou, Kyriacos Evangelou, Jameel Muzaffar, Wai Sum Cho

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引用次数: 0

Abstract

Objective: Spontaneous cerebrospinal fluid (sCSF) leaks of lateral skull base have little consensus on optimal management. We synthesized and evaluated current literature via systematic and meta-analysis to compare the success rates and complications of the different surgical techniques for middle cranial fossa (MCF) sCSF leak repair.

Data sources: MEDLINE, EMBASE, and Cochrane Library.

Review methods: Studies selected concerned surgical treatment of MCF sCSF leak. Data extracted included the following: study characteristics, patient characteristics, primary outcomes, and secondary outcomes.

Results: From 297 repairs with a MCF approach, the complication rate was 16.2% (95% CI: 12.3%-21.1%, I² = 0%, P = .052), compared to transmastoid (TM) 12.2% (95% CI: 6.7%- 21.2%, I² = 0%) in 82 repairs and for combined approaches 11.9% (95% CI: 4.2%-29.6%, I² = 58%) in 98 repairs. The rate of recurrence with the MCF approach was 3.2% (95% CI: 1%-6.4%, I² = 10%, P = .21) in 297 repairs, in the TM group the rate was 8.6% (95% CI: 4.7%-15%, I² = 0%) in 125 procedures and 1.1% in the combined approaches group (0%-4.5%, I² = 0%) in 139 procedures. Analysis of reoperation rates revealed a proportion of 0.9% (95% CI: 0%-4.4%, I² = 51%) in 287 repairs via the MCF approach. Reoperation rate was 8.6% (95% CI: 4.7%- 15%, I² = 0%) in 125 repairs via TM and 1.1% (95% CI: 0%-4.5%, I² = 0%) in 139 combined approach repairs.

Conclusion: There is no statistically significant difference in the outcomes of repair techniques. Decision making for the preferred approach will be dependent on the location, size and number of the defects, hearing status, and in consultation with the patient.

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自发性中颅窝脑脊液漏的手术效果比较：系统回顾和荟萃分析。

目的：侧颅底自发性脑脊液（sCSF）渗漏的最佳处理方法尚未达成共识。我们通过系统和meta分析对现有文献进行综合和评价，比较不同手术技术修复中颅窝（MCF） sCSF泄漏的成功率和并发症。数据来源：MEDLINE， EMBASE和Cochrane图书馆。综述方法：选取有关MCF - sCSF渗漏手术治疗的研究。提取的数据包括：研究特征、患者特征、主要结局和次要结局。结果：在297例MCF入路修复中，并发症发生率为16.2% (95% CI: 12.3%-21.1%, I2 = 0%, P = 0.052)，而经乳突（TM）在82例修复中为12.2% (95% CI: 6.7%- 21.2%, I2 = 0%)，而联合入路在98例修复中为11.9% （95% CI: 4.2%-29.6%, I2 = 58%）。在297例修复中，MCF入路的复发率为3.2% (95% CI: 1%-6.4%, I2 = 10%, P = 0.21)， TM组125例复发率为8.6% (95% CI: 4.7%-15%, I2 = 0%)，联合入路组139例复发率为1.1% （0%-4.5%,I2 = 0%）。再手术率分析显示，在287例经MCF入路的修复中，再手术率为0.9% （95% CI: 0%-4.4%, I2 = 51%）。经TM修复的125例再手术率为8.6% (95% CI: 4.7% ~ 15%, I2 = 0%)，经联合入路修复的139例再手术率为1.1% （95% CI: 0% ~ 4.5%, I2 = 0%）。结论：两种修复方法的疗效差异无统计学意义。决定首选的方法将取决于位置，大小和缺陷的数量，听力状况，并与患者协商。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Otolaryngology- Head and Neck Surgery 医学-耳鼻喉科学

CiteScore

6.70

自引率

2.90%

发文量

250

审稿时长

2-4 weeks

期刊介绍： Otolaryngology–Head and Neck Surgery (OTO-HNS) is the official peer-reviewed publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation. The mission of Otolaryngology–Head and Neck Surgery is to publish contemporary, ethical, clinically relevant information in otolaryngology, head and neck surgery (ear, nose, throat, head, and neck disorders) that can be used by otolaryngologists, clinicians, scientists, and specialists to improve patient care and public health.