内镜下第三脑室造瘘治疗I型Chiari畸形的良好临床结果和并发症：系统回顾和荟萃分析

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-08-26 DOI:10.1016/j.jocn.2025.111582

Marcelo Porto Sousa , Caio Vinicius Figueredo Almeida , Stefeson Gomes Cabral Junior , Pedro G.L.B. Borges , Leonardo B.O. Brenner , Marcio Yuri Ferreira , Filipi Fim Andreão , Sávio Batista , Felippe Figueiredo Torres Ribeiro , Fernando Campos Gomes Pinto , Wellingson S. Paiva , Jennifer S. Ronecker , Herika Negri Brito , Jamal McClendon , Raphael Bertani

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引用次数: 0

摘要

I型chiari畸形（CM-I）以小脑扁桃体突出为特征，通常需要后颅窝减压。然而，当脑脊液流动仍然受阻时，可能需要额外的干预措施，如内镜下第三脑室造口术（ETV）或脑室-腹膜分流术（VPS）。尽管在CM-I病例中经常使用ETV，但支持其疗效的证据仍然有限。为了解决这一差距，我们进行了一项更新的系统综述和荟萃分析，以评估CM-I患者的ETV结局。方法我们按照PRISMA指南，对Medline、Embase和Web of Science数据库进行了全面的检索。研究的纳入标准要求至少有3名患者，并关注症状改善、内镜下第三脑室造瘘成功、良好的临床结果和并发症等结果。结果从最初确定的502项研究中，选择了10项，涉及100名患者，包括4项研究中的30名儿童，中位随访时间为42个月。采用随机效应模型，联合分析显示98% （95% CI: 93% ~ 100%, I2 = 22%）的良好临床转归率。具体来说，与脑积水相关的症状改善率为97% (95% CI: 0.88—1.00,I2 = 16)，鼻窦症状改善率为78% （95% CI: 61%—96%,I2 = 21%）。总体并发症发生率为3% (95% CI: 0% ~ 8%, I2 = 0%)，儿科并发症发生率为0% （95% CI: 0% ~ 7%, I2 = 0%）。ETV成功率为92% （95% CI: 87% ~ 98%, I2 = 29%）。结论内镜下第三脑室造瘘术治疗脑积水和脊髓空洞有较好的疗效，且并发症少。它作为一种侵入性更小的分流替代方法的潜力强调了我们研究的重要性。

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Favorable clinical outcomes and complications of endoscopic third ventriculostomy in Chiari Malformation Type I: A systematic review and meta-analysis

Introduction

Chiari Malformation Type I (CM-I) is characterized by cerebellar tonsil herniation, often requiring posterior fossa decompression. However, when cerebrospinal fluid flow remains obstructed, additional interventions such as endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunting (VPS) may be necessary. Despite the frequent use of ETV in CM-I cases, evidence supporting its efficacy remains limited. To address this gap, we conducted an updated systematic review and meta-analysis to evaluate ETV outcomes in patients with CM-I.

Methods

We conducted a comprehensive search of the Medline, Embase, and Web of Science databases, adhering to PRISMA guidelines. The inclusion criteria for studies required a minimum of three patients and focused on outcomes such as symptom improvement, Endoscopic Third Ventriculostomy success, good clinical outcomes and complications.

Results

From 502 initially identified studies, 10 were selected, involving 100 patients, including 30 children across four studies, with a median follow-up of 42 months. Using random effects models, the combined analysis showed a 98 % (95 % CI: 93 % − 100 %, I² = 22 %) Favorable clinical outcomes rate. Specifically, symptom improvement related to hydrocephalus was observed at 97 % (95 % CI: 0.88–––1.00, I² = 16), and syrinx improvement at 78 % (95 % CI: 61 % − 96 %, I² = 21 %). Complication rates were 3 % (95 % CI: 0 % − 8 %, I² = 0 %) overall and 0 % (95 % CI: 0 % − 7 %, I² = 0 %) in the pediatric population. The ETV success rate was 92 % (95 % CI: 87 % − 98 %, I² = 29 %).

Conclusion

Endoscopic Third Ventriculostomy shows promising efficacy in treating hydrocephalus and syringomyelia, with minimal complications. Its potential as a less invasive alternative to shunts underscores the significance of our study.

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.