Muskens Ivo S, Briceno Vanessa, Ouwehand Tom L, Castlen Joseph P, Gormley William B, Aglio Linda S, Zamanipoor Najafabadi Amir H, van Furth Wouter R, Smith Timothy R, Mekary Rania A, Broekman Marike L D
Brain Center Rudolf Magnus, Utrecht University Medical Center, Utrecht, The Netherlands.
Department of Neurosurgery, University Medical Center Utrecht, HP G03.124, PO Box 85500, 3508GA, Utrecht, The Netherlands.
Acta Neurochir (Wien). 2018 Jan;160(1):59-75. doi: 10.1007/s00701-017-3390-y. Epub 2017 Nov 10.
OBJECT: In the past decade, the endonasal transsphenoidal approach (eTSA) has become an alternative to the microsurgical transcranial approach (mTCA) for tuberculum sellae meningiomas (TSMs) and olfactory groove meningiomas (OGMs). The aim of this meta-analysis was to evaluate which approach offered the best surgical outcomes. METHODS: A systematic review of the literature from 2004 and meta-analysis were conducted in accordance with the PRISMA guidelines. Pooled incidence was calculated for gross total resection (GTR), visual improvement, cerebrospinal fluid (CSF) leak, intraoperative arterial injury, and mortality, comparing eTSA and mTCA, with p-interaction values. RESULTS: Of 1684 studies, 64 case series were included in the meta-analysis. Using the fixed-effects model, the GTR rate was significantly higher among mTCA patients for OGM (eTSA: 70.9% vs. mTCA: 88.5%, p-interaction < 0.01), but not significantly higher for TSM (eTSA: 83.0% vs. mTCA: 85.8%, p-interaction = 0.34). Despite considerable heterogeneity, visual improvement was higher for eTSA than mTCA for TSM (p-interaction < 0.01), but not for OGM (p-interaction = 0.33). CSF leak was significantly higher among eTSA patients for both OGM (eTSA: 25.1% vs. mTCA: 10.5%, p-interaction < 0.01) and TSM (eTSA: 19.3%, vs. mTCA: 5.81%, p-interaction < 0.01). Intraoperative arterial injury was higher among eTSA (4.89%) than mTCA patients (1.86%) for TSM (p-interaction = 0.03), but not for OGM resection (p-interaction = 0.10). Mortality was not significantly different between eTSA and mTCA patients for both TSM (p-interaction = 0.14) and OGM resection (p-interaction = 0.88). Random-effect models yielded similar results. CONCLUSION: In this meta-analysis, eTSA was not shown to be superior to mTCA for resection of both OGMs and TSMs.
目的：在过去十年中，经鼻蝶窦入路（eTSA）已成为鞍结节脑膜瘤（TSM）和嗅沟脑膜瘤（OGM）显微外科经颅入路（mTCA）的替代方法。本荟萃分析的目的是评估哪种入路能提供最佳手术效果。 方法：根据PRISMA指南对2004年以来的文献进行系统回顾和荟萃分析。计算了eTSA和mTCA在全切除（GTR）、视力改善、脑脊液（CSF）漏、术中动脉损伤和死亡率方面的合并发生率，并给出p交互值。 结果：在1684项研究中，64个病例系列被纳入荟萃分析。采用固定效应模型，OGM患者中mTCA的GTR率显著更高（eTSA：70.9% vs. mTCA：88.5%，p交互值<0.01），但TSM患者中mTCA的GTR率无显著更高（eTSA：83.0% vs. mTCA：85.8%，p交互值=0.34）。尽管存在相当大的异质性，但TSM患者中eTSA的视力改善高于mTCA（p交互值<0.01），而OGM患者中则不然（p交互值=0.33）。OGM（eTSA：25.1% vs. mTCA：10.5%，p交互值<0.01）和TSM（eTSA：19.3%，vs. mTCA：5.81%，p交互值<0.01）患者中，eTSA的CSF漏均显著更高。TSM患者中eTSA的术中动脉损伤高于mTCA患者（4.89% vs. 1.86%，p交互值=0.03），但OGM切除术中则不然（p交互值=0.10）。TSM（p交互值=0.14）和OGM切除（p交互值=0.88）患者中，eTSA和mTCA患者的死亡率无显著差异。随机效应模型得出了类似的结果。 结论：在本荟萃分析中，对于OGM和TSM的切除，eTSA并未显示出优于mTCA。
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