Zumofen Daniel Walter, Rychen Jonathan, Roethlisberger Michel, Taub Ethan, Kalbermatten Daniel, Nossek Erez, Potts Matthew, Guzman Raphael, Riina Howard Antony, Mariani Luigi
Department of Neurosurgery, Basel University Hospital, Basel, Switzerland; Diagnostic and Interventional Neuroradiology Section, Department of Radiology and Nuclear Medicine, Basel University Hospital, Basel, Switzerland.
Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.
World Neurosurg. 2017 Feb;98:614-624. doi: 10.1016/j.wneu.2016.10.110. Epub 2016 Oct 27.
Conventional craniotomy approaches involve substantial soft tissue manipulation that can cause complications. The transciliary supraorbital keyhole approach was developed to avoid these complications. The aim of this review is to evaluate the safety and the effectiveness of the transciliary supraorbital keyhole approach.
We searched the PubMed/Medline database for full-text publications from 1996 onward containing data on 100 or more cases of aneurysm clipping or tumor resection by the transciliary supraorbital keyhole approach. The primary outcome was the incidence of approach-related complications. The secondary outcomes were the aneurysm occlusion rate and the extent of tumor resection.
Eight publications met the eligibility criteria. All publications were of the retrospective case-series or case-cohort type without any independent assessment of outcomes. The risk of bias at the individual study level may thus have influenced any conclusions drawn from the overall study population, which included 2783 patients with 3085 lesions (2508 aneurysms and 577 tumors). Approach-related complications included 3.3% cerebrospinal fluid collection or leak, 4.3% permanent and 1.6% temporary supraorbital hypesthesia, 2.9% permanent and 1% temporary facial nerve palsy, and 1% wound healing disturbance or wound infection. Complete aneurysm clipping was achieved in 97% of cases. Complete tumor resection in 90% of cases. The overall surgical revision rate was 2.5%. The esthetic outcome was typically reported as highly acceptable.
This approach may represent a safe, effective, and less invasive alternative to conventional craniotomies in experienced hands and for a well-selected subset of patients. However, higher-level evidence is needed to confirm this hypothesis.
传统开颅手术方法涉及大量软组织操作，可能导致并发症。经睫状上眶锁孔入路的开发是为了避免这些并发症。本综述的目的是评估经睫状上眶锁孔入路的安全性和有效性。
我们在PubMed/Medline数据库中检索了1996年以后的全文出版物，这些出版物包含经睫状上眶锁孔入路进行100例或更多例动脉瘤夹闭或肿瘤切除的数据。主要结局是与入路相关的并发症发生率。次要结局是动脉瘤闭塞率和肿瘤切除范围。
八项出版物符合纳入标准。所有出版物均为回顾性病例系列或病例队列类型，没有对结局进行任何独立评估。因此，个体研究水平的偏倚风险可能影响了从总体研究人群得出的任何结论，该总体研究人群包括2783例患者和3085个病灶（2508个动脉瘤和577个肿瘤）。与入路相关的并发症包括3.3%的脑脊液积聚或漏出、4.3%的永久性和1.6%的暂时性眶上感觉减退、2.9%的永久性和1%的暂时性面神经麻痹，以及1%的伤口愈合障碍或伤口感染。97%的病例实现了完全动脉瘤夹闭。90%的病例实现了完全肿瘤切除。总体手术翻修率为2.5%。美学效果通常被报告为高度可接受。
在经验丰富的医生手中，对于精心挑选的一部分患者，这种入路可能是传统开颅手术的一种安全、有效且侵入性较小的替代方法。然而，需要更高水平的证据来证实这一假设。
