Lai Leon T, Danesh-Meyer Helen V, Kaye Andrew H
Department of Neurosurgery, Level 4 East, The Royal Melbourne Hospital, Grattan Street, Parkville, Melbourne, VIC 3050, Australia.
Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia; Department of Ophthalmology, University of Auckland, Auckland, New Zealand.
J Clin Neurosci. 2014 Oct;21(10):1670-8. doi: 10.1016/j.jocn.2014.02.025. Epub 2014 Jun 25.
The optimal surgical management for medically refractory idiopathic intracranial hypertension (IIH) is not well established. Few studies have directly compared headache and visual outcomes across treatment modalities. A systematic analysis of case series was conducted to compare therapeutic efficacies among currently available interventions. The electronic databases from EMBASE (1980-17 September 2013), Medline (1980-17 September 2013), Cochrane databases, and references of review articles was searched. All publications reporting headache and visual outcomes following intervention for IIH were included. A total of 457 manuscripts were selected and full text analysis produced 30 studies with extractable data. All studies constituted Class III evidence. Overall, 332 patients treated by optic nerve sheath fenestration (ONSF), 287 by lumboperitoneal shunt (LPS), 61 by ventriculoperitoneal shunt (VPS), and 88 by dural venous sinus stenting, were identified. Visual acuity improved in 49.3%, 56.6%, 67.2% and 84.6% of patients following VPS, LPS, ONSF, and stent placements, respectively. Resolution of papilledema was noted in 59.9% to 97.1%. Postoperative headache improved in 36.5%, 62.5%, 75.2%, and 82.9% of patients treated with ONSF, VPS, LPS, and stenting, respectively. Shunt revision was more frequent for LPS compared to VPS (46% versus 36%; p<0.2). Among the LPS revisions, 87.5% occurred within the first 12 months following initial surgery. Our pooled analysis indicated an overall similar improvement in visual outcomes across treatment modalities, and a modest improvement in headache following cerebrospinal fluid shunting and endovascular stent placement. Based on currently available literature, there is insufficient evidence to recommend or reject any treatments modalities for IIH.
对于药物治疗无效的特发性颅内高压（IIH），最佳手术治疗方案尚未明确确立。很少有研究直接比较不同治疗方式下的头痛和视力预后情况。我们进行了一项病例系列的系统分析，以比较现有干预措施之间的治疗效果。检索了EMBASE（1980年至2013年9月17日）、Medline（1980年至2013年9月17日）、Cochrane数据库以及综述文章的参考文献等电子数据库。纳入所有报告IIH干预后头痛和视力预后情况的出版物。共筛选出457篇手稿，全文分析得到30项具有可提取数据的研究。所有研究均为III级证据。总体而言，共确定了332例接受视神经鞘开窗术（ONSF）治疗的患者、287例接受腰大池腹腔分流术（LPS）治疗的患者、61例接受脑室腹腔分流术（VPS）治疗的患者以及88例接受硬脑膜静脉窦支架置入术治疗的患者。VPS、LPS、ONSF和支架置入术后，视力改善的患者分别占49.3%、56.6%、67.2%和84.6%。视乳头水肿消退的比例在59.9%至97.1%之间。接受ONSF、VPS、LPS和支架置入术治疗的患者中，术后头痛改善的比例分别为36.5%、62.5%、75.2%和82.9%。与VPS相比，LPS的分流管修订更为频繁（46%对36%；p<0.2）。在LPS的修订中，87.5%发生在初次手术后的前12个月内。我们的汇总分析表明，各治疗方式在视力预后方面总体改善相似，脑脊液分流术和血管内支架置入术后头痛有适度改善。基于现有文献，尚无足够证据推荐或拒绝IIH的任何治疗方式。
