静脉窦支架置入术治疗自发性颅底脑脊液泄漏：一项系统回顾和荟萃分析。

IF 1.7 4区医学 Q3 Medicine

Interventional Neuroradiology Pub Date : 2025-02-06 DOI:10.1177/15910199241311626

Jordan M Rasmussen, Kautilya R Patel, Daniel L Surdell, William E Thorell, Nicholas Borg, Patrick J Opperman, Geoffrey Casazza, Anne K Maxwell, Christie Barnes, Samuel Pate, Cindy M Schmidt, Mithun G Sattur

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引用次数: 0

摘要

背景：特发性颅内高压（IIH）与自发性颅底脑脊液（CSF）泄漏密切相关。静脉窦支架（VSS）已被证明是治疗IIH的有效方法。因此，其在自发性颅底脑脊液泄漏中的作用正在被积极探讨。方法：我们在EMBASE、MEDLINE、Scopus、Cochrane图书馆和谷歌Scholar上进行了系统的文献检索，以确定报告使用VSS治疗自发性颅底脑脊液泄漏的研究。排除了儿童患者、非英文文章和非自发性泄漏的研究。治疗失败（脑脊液泄漏持续/复发）被视为主要结局。结果：纳入8项研究，62例自发性颅底脑脊液渗漏患者行VSS治疗。患者平均年龄51.9岁；87.5%为女性。肥胖非常普遍，平均体重指数为33.9 kg/m2（4项研究）。74.6%的患者存在IIH（7项研究）。单纯行VSS 26例（41.9%），手术修复+ VSS 36例（58.1%）。7例（11.3%）患者治疗失败。一项研究中的三次失败不能明确地归因于任何一组。因此，单独VSS的估计失败率从18.6% （95% CI[0.02 - 0.46]）到26.4% (95% CI[0.11 - 0.46])，而手术修复+ VSS的失败率从5.5% （95% CI[0.00 - 0.16]）到12.2% （95% CI[0.01 - 0.32]）。此外，估计伴随iih相关症状的缓解率为88.7% （95% CI[0.75 - 0.98%]）。大多数研究未报告与VSS相关的任何严重并发症或死亡率。结论：VSS在自发性颅底脑脊液漏的治疗中具有潜在的作用。作为单独治疗与辅助手术修复的确切适应症，以及成功治疗的预测因素仍有待确定。

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Venous sinus stenting for management of spontaneous skull-base CSF leaks: A systematic review and meta-analysis.

Background: Idiopathic intracranial hypertension (IIH) is strongly associated with spontaneous skull-base cerebrospinal fluid (CSF) leaks. Venous sinus stenting (VSS) has proven effective for the treatment of IIH. Hence, its role in spontaneous skull-base CSF leaks is being explored actively.

Methods: We performed a systematic literature search across EMBASE, MEDLINE, Scopus, The Cochrane Library, and Google Scholar to identify studies reporting the use of VSS for spontaneous skull-base CSF leaks. Studies with pediatric patients, non-English articles, and nonspontaneous leaks were excluded. Failure of treatment (persistence / recurrence of CSF leak) was regarded as the primary outcome.

Results: Eight studies with 62 patients undergoing VSS for spontaneous skull-base CSF leaks were included. Mean age of the patients was 51.9 years; 87.5% were females. Obesity was highly prevalent, with a mean body mass index of 33.9 kg/m² (4 studies). IIH was noted in 74.6% patients (7 studies). Twenty-six patients (41.9%) underwent VSS alone whereas 36 patients (58.1%) underwent surgical repair + VSS. Seven patients (11.3%) had a failure of treatment. Three failures from one study could not be definitively ascribed to either of the groups. Hence, the estimated failure rate for VSS alone ranged from 18.6% (95% CI [0.02 - 0.46]) to 26.4% (95% CI [0.11 - 0.46]), whereas that for surgical repair + VSS ranged from 5.5% (95% CI [0.00 - 0.16]) to 12.2% (95% CI [0.01 - 0.32]). Furthermore, the estimated rate for resolution of concomitant IIH-related symptoms was 88.7% (95% CI [0.75 - 0.98%]). Majority of the studies did not report any serious complications or mortality related to VSS.

Conclusion: VSS has a potential role in the management of spontaneous skull-base CSF leaks. Its exact indications as a standalone treatment versus as an adjuvant to surgical repair, and the predictors for successful treatment remain to be defined.

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来源期刊

Interventional Neuroradiology 医学-核医学

CiteScore

2.80

自引率

11.80%

发文量

192

审稿时长

6-12 weeks

期刊介绍： Interventional Neuroradiology (INR) is a peer-reviewed clinical practice journal documenting the current state of interventional neuroradiology worldwide. INR publishes original clinical observations, descriptions of new techniques or procedures, case reports, and articles on the ethical and social aspects of related health care. Original research published in INR is related to the practice of interventional neuroradiology...