清醒开颅与全麻切除轴内脑肿瘤：系统回顾和荟萃分析

IF 0.4 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management Pub Date : 2025-03-06 DOI:10.1016/j.inat.2025.102007

Mohammad Hamza Bajwa , Nowal Hussain , Muhammad Waqas Saeed Baqai , Faiza Urooj , Unaiza Naeem , Syed Hasan Shuja , Ali Hyder Nazeer , Ahsan Ali Khan , Syed Ather Enam , Saqib Kamran Bakhshi

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引用次数: 0

摘要

背景：清醒开颅术（AC）治疗轴内脑肿瘤有助于保存可能有肿瘤侵袭的皮层和皮层下白质束。没有具体的指南或具体的证据表明AC优于全身麻醉（GA）手术，许多外科医生更倾向于在全身麻醉下切除，因为切除的范围可能更大。方法按照PRISMA指南进行系统评价和荟萃分析，并在PROSPERO注册（CRD42022311131）。从PubMED和Cochrane数据库中使用布尔运算符的特定关键词和MeSH术语进行了全面的搜索。使用Mantel-Haenszel随机效应模型估计合并效应大小，使用Higgins I2统计量评估异质性。结果929篇文献中，10篇纳入定量分析。选定的研究包括1974例患者（AC组681例，GA组1293例）。GA组和AC组在切除范围（MD: 3.77, p = 0.38, I2 = 91%）、总切除率（OR: 1.20, p = 0.69, I2 = 74%）、OR时间（MD: 5.96, p = 0.15, I2 = 0%）或住院时间（MD: - 3.39, p = 0.21, I2 = 92%）方面均无显著差异。结论在颅脑轴内肿瘤的切除范围上，颅脑手术的GTR率和EOR率相当，不逊于手术。虽然不显著，但目前的数据趋势是AC组患者的手术时间和住院时间也更短。

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Awake craniotomy versus general anesthesia for resection of intra-axial brain tumors: A systematic review and meta-analysis

Background

Awake craniotomy (AC) for intra-axial brain tumors is useful for preserving cortical and subcortical white matter tracts that may have tumor invasion. No specific guideline or concrete evidence exists regarding the superiority of AC over surgery under general anesthesia (GA), with many surgeons preferring resection under GA for benefits of potentially better extent of resection.

Methods

A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered on PROSPERO(CRD42022311131). A comprehensive search was conducted using specific keywords and MeSH terms with Boolean operators, from PubMED and Cochrane databases. Pooled effect size was estimated using a Mantel-Haenszel random-effects model, with evaluation of heterogeneity using Higgins I² statistic.

Results

Of 929 articles, ten were included for quantitative analysis. Selected studies included 1974 patients (681 in the AC group, 1293 in the GA group). No significant differences were seen between GA and AC groups in terms of extent of resection (MD: 3.77, p = 0.38, I2 = 91 %), rates of gross total resection (OR: 1.20, p = 0.69, I2 = 74 %), OR time (MD: 5.96, p = 0.15, I2 = 0 %), or length of stay (MD: −3.39, p = 0.21, I2 = 92 %).

Conclusion

AC is not inferior to surgery under GA for extent of resection of intra-axial brain tumors, with comparable rates of GTR and EOR. While non-significant, current data trends towards shorter operating time and length of stay as well for AC group patients.

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