Microsurgery vs. Gamma Knife Radiosurgery for the Treatment of Brainstem Cavernous Malformations: A Systematic Review and Meta-Analysis.
Microsurgery vs. Gamma Knife Radiosurgery for the Treatment of Brainstem Cavernous Malformations: A Systematic Review and Meta-Analysis.
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显微外科手术与伽玛刀放射外科治疗脑干海绵状血管瘤：系统评价和荟萃分析
DOI：
10.3389/fneur.2021.600461
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发表时间：
2021
影响因子：
3.4
通讯作者：
Jiang X
中科院分区：
文献类型：
--
作者：
Gao X;Yue K;Sun J;Cao Y;Zhao B;Zhang H;Dai S;Zhang L;Luo P;Jiang X
背景：脑干海绵状血管畸形（BSCMs）是脑海绵状血管畸形的一个子集，其位置危险，临床病程可能具有毁灭性。显微手术或伽玛刀放射外科（GKRS）治疗BSCMs的效果和结果在不同研究中有所差异。
方法：我们检索了Medline、Web of Science、Cochrane图书馆、PubMed和中国生物医学文献数据库，以获取在同行评审期刊上发表的队列研究原始文章，这些文章报道了20例或更多任何年龄的BSCMs患者，且随访完成率至少为80%。
结果：我们纳入了43个队列，涉及2492名患者。显微手术（RR = 0.04，95% CI 0.01 - 0.16，P < 0.01）和GKRS（RR = 0.11，95% CI 0.08 - 0.16，P < 0.01）在降低BSCMs治疗后的再出血率方面均显示出良好的疗效。神经外科手术后复合结局的发生率为19.8（95% CI 16.8 - 22.8），放射外科手术后为15.7（95% CI 11.7 - 19.6）。此外，我们发现神经外科队列和放射外科队列在有症状颅内出血（ICH；神经外科队列：中位数为0，范围0 - 33；放射外科队列：中位数为4，范围1 - 14；P < 0.05）和持续性局灶性神经功能缺损（FND；神经外科队列：中位数为5，范围0 - 140；放射外科队列：中位数为1，范围0 - 3；P < 0.05）方面患者的中位数数量存在统计学显著差异。
结论：所报道的显微手术或GKRS治疗BSCMs的效果有利于减少BSCMs的复发性出血。神经外科队列中的患者有症状ICH的发生率较低，而放射外科队列中的患者持续性FND的发生率较低。
Background: Brainstem cavernous malformations (BSCMs) are a subset of cerebral cavernous malformations with precarious locations and potentially devastating clinical courses. The effects and outcomes of treating BSCMs by microsurgery or gamma knife radiosurgery (GKRS) vary across studies. Methods: We searched the Medline, Web of Science, The Cochrane Library, PubMed, and China Biology Medicine disc databases for original articles published in peer-reviewed journals of cohort studies reporting on 20 or more patients of any age with BSCMs with at least 80% completeness of follow-up. Results: We included 43 cohorts involving 2,492 patients. Both microsurgery (RR = 0.04, 95% CI 0.01–0.16, P < 0.01) and GKRS (RR = 0.11, 95% CI 0.08–0.16, P < 0.01) demonstrated great efficacy in reducing the rehemorrhage rate after treatment for BSCMs. The incidence rates of composite outcomes were 19.8 (95% CI 16.8–22.8) and 15.7 (95% CI 11.7–19.6) after neurosurgery and radiosurgery, respectively. In addition, we found statistically significant differences in the median numbers of patients between neurosurgical and radiosurgical cohorts in terms of symptomatic intracranial hemorrhage (ICH; neurosurgical cohorts: median 0, range 0–33; radiosurgical cohorts: median 4, range 1–14; P < 0.05) and persistent focal neurological deficit (FND; neurosurgical cohorts: median 5, range 0–140; radiosurgical cohorts: median 1, range 0–3; P < 0.05). Conclusions: The reported effects of treating BSCMs by microsurgery or GKRS are favorable for reducing recurrent hemorrhage from BSCMs. Patients in the neurosurgery cohort had a lower incidence of symptomatic ICH, while patients in the radiosurgical cohort had a lower incidence of persistent FND.
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