Ovarian resection in anti-N-methyl-D-aspartate receptor encephalitis: A comparison of surgical approaches.
Ovarian resection in anti-N-methyl-D-aspartate receptor encephalitis: A comparison of surgical approaches.
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DOI：
10.3389/fneur.2022.1043785
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发表时间：
2022
影响因子：
3.4
通讯作者：
Tang-Wai, David F.
中科院分区：
文献类型：
--
作者：
Iyengar, Yajur;Hebert, Julien;Climans, Seth A.;Muccilli, Alexandra;Lee, Sydney;Boruah, Abhilasha P.;Thakur, Kiran T.;Solnik, Jonathon;Wennberg, Richard A.;Day, Gregory S.;Tang-Wai, David F.
对于患有抗N-甲基-D-天冬氨酸受体脑炎（NMDARE）和卵巢畸胎瘤的患者，“保守”手术方法（完全或部分单侧卵巢切除术或双侧部分卵巢切除术）与临床改善相关。“侵袭性”卵巢切除术（完全双侧卵巢切除术或术前无畸胎瘤证据的“盲”卵巢切除术）也有报道，尽管支持这些方法的证据尚不清楚。比较接受保守与积极卵巢切除术的NMDARE患者的1年功能结局。从三家北美三级护理中心回顾性确定了2012年1月1日至2021年12月31日期间接受卵巢切除术的NMDARE患者。主要结果是卵巢切除术后1年的改良兰金量表评分为0-2分。Fisher精确和Wilcoxon秩和检验用于比较两个手术组之间的人口统计学特征、疾病特征和功能结局。还对基于手术入路报告功能结局的研究进行了固定效应荟萃分析。共纳入23例患者。8例接受了积极的手术治疗。积极的手术治疗与发病年龄较小、基线疾病严重程度较高和治疗延迟时间较长之间的相关性无显著趋势。“积极”（38，38%）和“保守”（11/15，73%）管理组在实现主要结局方面没有差异（OR 95%= <0.1-1.9; p = 0.18）。当考虑两项已发表研究中52例患者的数据时，结果相似（RR = 0.74; CI 95%= 0.48-1.13; p = 0.16）。在本系列中，侵袭性卵巢切除术与NMDARE患者的结局改善无关。组间差异可能是原因之一，接受积极切除的患者病情往往更重，手术在病程后期进行。根据现有证据，我们主张对影像学证实/疑似畸胎瘤患者进行功能保留切除术，对传统治疗难治的NMDARE高危患者进行重复多模式影像学检查。
For patients with anti-N-methyl-D-aspartate receptor encephalitis (NMDARE) and ovarian teratoma, “conservative” surgical approaches (complete or partial unilateral oophorectomy or bilateral partial oophorectomies) are associated with clinical improvement. “Aggressive” ovarian resections (complete bilateral oophorectomy or “blind” ovarian resections without pre-operative evidence of teratoma) are also reported, although the evidence supporting these approaches is unclear. To compare the one-year functional outcomes of patients with NMDARE who underwent conservative vs. aggressive ovarian resections. Patients with NMDARE undergoing ovarian resection between January 1st, 2012 and December 31st, 2021 were retrospectively identified from three North American tertiary care centers. Primary outcome was a modified Rankin Scale score of 0–2 one year after ovarian resection. Fisher exact and Wilcoxon rank sum tests were used to compare demographic features, disease characteristics, and functional outcomes between the two surgical groups. A fixed-effects meta-analysis of studies reporting functional outcomes based on surgical approach was also performed. Twenty-three patients were included. Eight underwent aggressive surgical management. There was a non-significant trend toward an association between aggressive surgical management and younger age-at-onset, higher baseline disease severity, and longer delays to treatment. There was no difference between “aggressive” (3/8, 38%) and “conservative” (11/15, 73%) management groups in achieving the primary outcome (OR95% = <0.1–1.9; p = 0.18). Findings were similar when considering data from 52 patients in two published studies (RR = 0.74; CI95% = 0.48–1.13; p = 0.16). Aggressive ovarian resection was not associated with improved outcomes in patients with NMDARE in this series. Group differences may have contributed, recognizing that patients who underwent aggressive resection tended to be sicker, with procedures performed later in the disease course. Based on available evidence, we advocate for function-sparing resection in patients with imaging-confirmed/suspected teratoma, and repeated multi-modal imaging in at-risk patients with NMDARE refractory to conventional treatment.
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DOI：
10.3988/jcn.2021.17.1.131
发表时间：
2021-01
期刊：
Journal of clinical neurology (Seoul, Korea)
影响因子：
--
作者：
Hong SB;Shin YW;Shin YW;Lee SK;Chu K
通讯作者：
Chu K
影响因子：
9.9
作者：
Balu, Ramani;McCracken, Lindsey;Titulaer, Maarten J.
通讯作者：
Titulaer, Maarten J.
影响因子：
29
作者：
Day, Gregory S.;Laiq, Simin;Munoz, David G.
通讯作者：
Munoz, David G.
影响因子：
5.6
作者：
Wu CY;Wu JD;Chen CC
通讯作者：
Chen CC
DOI：
10.1016/j.eurox.2021.100129
发表时间：
2021-07
影响因子：
--
作者：
El Hanna J;Quenum C;Arsalane A
通讯作者：
Arsalane A