Ghobrial George M, Dalyai Richard T, Maltenfort Mitchell G, Prasad Srinivas K, Harrop James S, Sharan Ashwini D
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
World Neurosurg. 2015 May;83(5):829-35. doi: 10.1016/j.wneu.2014.06.044. Epub 2014 Jun 27.
To identify surgical practice patterns in the literature for nonpediatric syringomyelia by systematic review and to determine the following: 1) What is the best clinical practice of cerebrospinal fluid (CSF) diversion to maximize clinical improvement or to achieve the lowest recurrence rate? 2) Does arachnolysis, rather than CSF diversion, lead to prolonged times to clinical recurrence?
A database search comprising PubMed, Cochrane Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Cochrane Database of Systematic Reviews was conducted to find pertinent articles on postinfectious, posttraumatic, or idiopathic syringomyelia.
An advanced PubMed search in August 2012 yielded 1350 studies, including 12 studies meeting Oxford Centre for Evidence-Based Medicine criteria for level IV evidence as a case series, with a total of 410 patients (mean age, 39 years). Data on 486 surgeries were collected. Mean follow-up data were available for 10 studies, with a mean follow-up time of 62 months. On regression analysis, increased age had a significant correlation with a higher likelihood of having clinically significant recurrence on mean follow-up (P < 0.05). The use of arachnolysis in surgery was associated with a longer duration until clinically symptomatic recurrence (P = 0.02). Data on mortality were unavailable. The mean number of surgeries per patient across all studies was 1.20 (range, 0.95-2.00).
With postinfectious and posttraumatic etiologies, arachnolysis was the only surgical treatment to have a statistically significant effect on decreasing recurrence rates. More prospective, randomized, controlled studies are required to reach a clear consensus.
通过系统评价确定文献中关于非小儿脊髓空洞症的手术治疗模式，并确定以下内容：1）脑脊液（CSF）分流的最佳临床实践是什么，以实现最大程度的临床改善或达到最低的复发率？2）蛛网膜粘连松解术而非脑脊液分流术是否会导致临床复发时间延长？
进行数据库检索，包括PubMed、Cochrane对照试验注册库、护理及相关健康文献累积索引（CINAHL）、Scopus和Cochrane系统评价数据库，以查找关于感染后、创伤后或特发性脊髓空洞症的相关文章。
2012年8月在PubMed上进行的高级检索得到1350项研究，其中12项研究符合牛津循证医学中心IV级证据标准，作为病例系列，共有410例患者（平均年龄39岁）。收集了486例手术的数据。10项研究可获得平均随访数据，平均随访时间为62个月。回归分析显示，年龄增加与平均随访时临床显著复发的可能性更高显著相关（P<0.05）。手术中使用蛛网膜粘连松解术与临床症状复发的持续时间更长相关（P = 0.02）。无死亡率数据。所有研究中每位患者的平均手术次数为1.20（范围0.95 - 2.00）。
对于感染后和创伤后病因，蛛网膜粘连松解术是唯一对降低复发率有统计学显著影响的手术治疗方法。需要更多前瞻性、随机、对照研究以达成明确共识。
