Optic neuropathy related to Onodi cell mucocele: a systematic review and meta-analysis of randomized controlled trials

IF 0.4 Q4 MEDICINE, RESEARCH & EXPERIMENTAL
T. Mahfoz, A. K. Alnemare
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引用次数: 1

Abstract

Background Onodi cells (OC) are important for rhinologists because they contain the optic canal, and are close to the optic nerve and internal carotid artery. Therefore, any pathologic processes within OCs, including infectious or inflammatory sinusitis, fungus ball, inverted papilloma, mucocele, or sino-nasal malignancy can cause devastating ophthalmologic complications. We aimed to define the different optic neuropathy conditions related to isolated OC mucoceles, determine the different symptoms of each condition and its risk factors, and explore the efficacy of the relevant diagnostic tools and treatment strategies. Methodology A comprehensive electronic search with time and language restrictions was conducted. Several known databases were included: PubMed, The Cochrane Library, and Web of Science from 1990 to 2020. We combined the search terms and limited the study to the English language. We removed duplicates, and the articles were screened based on title, abstract, and full text according to the PRISMA checklist. Results The electronic search strategy conducted in this review resulted in 409 hits. After removing duplicate studies and studies with inadequate information, 20 case studies were finally included in this analysis, 65% of which presented men (n = 13), and seven presented women (35%). The mean age reported in these studies was 54.75 with a standard deviation of 14.62 years. We found that visual disturbances that can lead to visual loss were present in most cases (75% of cases). Other symptoms included headache (35%) and eye pain (30%). The risk factors for developing optic neuropathy conditions related to OC mucoceles include being Asian and elderly with a history of either nasal or eye conditions. Our findings showed that the mean time between the onset of symptoms and intervention was 16.8 ± 21.8 days. Most patients underwent endoscopic sinus surgery to remove the OC mucocele (18/20; 90%) with a success rate of 77%. Pharmacologic intervention as a solo treatment (IV corticosteroids or /and antibiotic) was used in only six patients, with a success rate of only 33%. Computed tomography (CT) and magnetic resonance imaging (MRI) is the most commonly used diagnostic tools, with diagnostic success rates of 40% and 82.3%, respectively. Conclusion Optic neuropathy conditions related to OC mucoceles are very rare. However, a higher incidence of these conditions was observed in elderly Asian patients with a history of nasal or optic conditions. Visual disturbances are the most common symptoms accompanying any type of eye condition. Endoscopic sinus surgery is considered an effective and safe intervention for these patients, and the period between the onset of symptoms and surgery does not affect the outcomes of the surgery. Furthermore, treatment with corticosteroids and/or antibiotics cannot replace surgery and it can also worsen the condition. Moreover, MRI is superior to CT scans for demonstrating this abnormality, and both are superior to other diagnostic tools. Finally, further investigations should be conducted to study the causes of the low incidence of these conditions in the eastern region.
与Onodi细胞黏液囊肿相关的视神经病变:随机对照试验的系统回顾和荟萃分析
donodi细胞(OC)对鼻医生来说很重要,因为它们包含视神经管,并且靠近视神经和颈内动脉。因此,OCs内的任何病理过程,包括感染性或炎症性鼻窦炎、真菌球、内翻性乳头状瘤、粘液囊肿或中鼻恶性肿瘤,都可能导致毁灭性的眼科并发症。我们旨在定义与孤立性OC粘液囊肿相关的不同视神经病变状况,确定每种状况的不同症状及其危险因素,并探讨相关诊断工具和治疗策略的疗效。方法采用有时间和语言限制的综合电子检索方法。包括几个已知的数据库:PubMed, Cochrane图书馆和Web of Science,从1990年到2020年。我们结合了搜索条件,并将研究限制在英语语言中。我们删除重复,并根据PRISMA检查表对文章进行标题、摘要和全文筛选。结果本综述中采用的电子检索策略共获得409条检索结果。在剔除重复研究和信息不充分的研究后,该分析最终纳入了20个案例研究,其中65%为男性(n = 13), 7例为女性(35%)。这些研究报告的平均年龄为54.75岁,标准差为14.62岁。我们发现,大多数病例(75%的病例)存在可导致视力丧失的视觉障碍。其他症状包括头痛(35%)和眼痛(30%)。与OC黏液囊肿相关的视神经病变的危险因素包括亚洲人和有鼻部或眼部病史的老年人。我们的研究结果显示,从症状出现到干预的平均时间为16.8±21.8天。大多数患者接受内窥镜鼻窦手术切除OC粘液囊肿(18/20;90%),成功率为77%。药物干预作为单独治疗(静脉注射皮质类固醇或/和抗生素)仅在6例患者中使用,成功率仅为33%。计算机断层扫描(CT)和磁共振成像(MRI)是最常用的诊断工具,诊断成功率分别为40%和82.3%。结论与OC黏液囊肿相关的视神经病变非常罕见。然而,在有鼻或视神经病史的亚洲老年患者中,这些疾病的发生率较高。视力障碍是伴随任何类型的眼病的最常见症状。内窥镜鼻窦手术被认为是对这些患者有效和安全的干预措施,并且症状出现和手术之间的时间不影响手术的结果。此外,皮质类固醇和/或抗生素治疗不能代替手术,而且还会使病情恶化。此外,MRI在显示这种异常方面优于CT扫描,两者都优于其他诊断工具。最后,应进一步调查东部地区这些疾病发病率低的原因。
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
AIMS Medical Science
AIMS Medical Science MEDICINE, RESEARCH & EXPERIMENTAL-
自引率
14.30%
发文量
20
审稿时长
12 weeks
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