后窝蛛网膜囊肿手术后症状和影像学改善：元分析和文献综述。

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery Pub Date : 2024-12-01 DOI:10.1016/j.wneu.2024.09.061

Gavin M. Lockard , Keaton Piper , Zeegan George , Adam Alayli , Elliot Neal , Farina Klocksieben , Nour Shaheen , Oliver Flouty

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引用次数: 0

摘要

目的：蛛网膜囊肿是一种良性的硬脑膜内脑脊液聚集，通常没有症状，但在极少数情况下会增大并可能引起症状。当蛛网膜囊肿位于后窝时，症状会有很大差异，手术指征也不明确。本研究旨在探讨后窝蛛网膜囊肿（PFAC）手术后的影像学和症状结果：方法：利用PubMed对所有涉及≥5名接受手术治疗的PFAC患者的研究进行文献综述。进行了单臂荟萃分析，以评估术后放射学改善情况。由于出现的症状多种多样，因此不利于进行荟萃分析，但还是详细报告了结果：结果：9篇文献，67名患者符合纳入标准。切除/瘘是最常见的手术（n=60）。较少见的手术包括CP分流术（2例）、同期切除术/脑膜剥脱术和ETV（4例），还有一名患者同时接受了VP/CP分流术。文献综述显示，90% 的患者头痛症状有所改善；88% 的患者小脑症状有所改善；92% 的患者恶心/呕吐症状有所改善；78% 的患者听力下降；60% 的患者耳鸣；91% 的患者视力障碍有所改善。对七项报告术后放射性大小的研究进行的 Meta 分析表明，75% 的人出现 PFAC 大小减小（效应大小：0.75，95% CI：0.50-0.94）：结论：虽然 PFAC 手术的影像学改善率很高，但术后改善率不同的症状表现也多种多样。这项研究加强了就 PFAC 手术的症状结果进行术前咨询的重要性，并提供了支持性统计分析，但受到可用样本量的限制。

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Symptomatic and Radiographic Improvement Following Surgery for Posterior Fossa Arachnoid Cysts: Meta-Analysis and Literature Review

Objective

Arachnoid cysts are benign, intradural collections of cerebrospinal fluid that are often asymptomatic but, in rare instances, will grow and may cause symptoms. When these are in the posterior fossa, the symptomatology greatly ranges, and the indications for surgery are not well defined. The objective of this study is to examine radiographic and symptomatic outcomes following surgery for posterior fossa arachnoid cysts (PFAC).

Methods

A literature review was performed utilizing PubMed for all studies involving ≥5 patients with PFACs who underwent surgery. A single-arm meta-analysis was performed to assess the postoperative radiographic improvement. Given the heterogeneous variety of presenting symptoms, these were not conducive to meta-analyses but the outcomes are reported in detail.

Results

Nine publications with 67 patients met inclusion criteria. Excision/fenestration was the most common operation (n = 60). Less common included cystoperitoneal shunts (n = 2), concurrent excision/fenestration and endoscopic third ventriculostomy (n = 4), and one patient who underwent concurrent ventriculoperitoneal/cystoperitoneal shunts. This literature review revealed improvement of headache in 90% of patients; 88% with cerebellar symptoms; 92% with nausea/emesis; 78% with hearing loss; 60% with tinnitus; and 91% with vision deficits. Meta-analysis of 7 studies reporting postoperative radiographic size demonstrated that 75% of people experienced decreased PFAC size (effect size: 0.75, 95% confidence interval: 0.50–0.94).

Conclusions

Although there is a high rate of radiographic improvement for PFAC surgery, there is a wide variety of presenting symptoms with differing postoperative improvement rates. This study reinforces the importance of preoperative counseling regarding symptomatic outcomes for PFAC surgery, with supporting statistical analysis but limited by the sample sizes available.

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来源期刊

World neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

3.90

自引率

15.00%

发文量

1765

审稿时长

47 days

期刊介绍： World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS