Goyal Anshit, Lu Victor M, Yolcu Yagiz U, Elminawy Mohamed, Daniels David J
Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
Childs Nerv Syst. 2018 Sep;34(9):1627-1637. doi: 10.1007/s00381-018-3852-4. Epub 2018 Jun 30.
Surgery for craniosynostosis remains a crucial element in successful management. Intervention by both endoscopic and open approaches has been proven effective. Given the differences in timing and indications for these procedures, differences in perioperative outcomes have yet to be thoroughly compared between the two approaches. The aim of the systematic review and meta-analysis was to assess the available evidence of perioperative outcomes between the two approaches in order to better influence the management paradigm of craniosynostosis.
We followed recommended PRISMA guidelines for systematic reviews. Seven electronic databases were searched to identify all potentially relevant studies published from inception to February 2018 which were then screened against a set of selection criteria. Data were extracted and analyzed using meta-analysis of proportions.
Twelve studies satisfied all the selection criteria to be included, which described a pooled cohort involving 2064 craniosynostosis patients, with 965 (47%) and 1099 (53%) patients undergoing surgery by endoscopic and open approaches respectively. When compared to the open approach, it was found that the endoscopic approach conferred statistically significant reductions in blood loss (MD = 162.4 mL), operative time (MD = 112.38 min), length of stay (MD = 2.56 days), and rates of perioperative complications (OR = 0.58), reoperation (OR = 0.37) and transfusion (OR = 0.09), where all p < 0.001.
Both endoscopic and open approaches for the surgical management of craniosynostosis are viable considerations. The endoscopic approach confers a significant reduction in operative and postoperative morbidity when compared to the open approach. Given that specific indications for either approach should be considered when managing a patient, the difference in perioperative outcomes remain an important element of this paradigm. Future studies will validate the findings of this study and consider long-term outcomes, which will all contribute to rigor of craniosynostosis management.
颅骨缝早闭的手术治疗仍是成功治疗的关键环节。内镜和开放手术方法均已被证明有效。鉴于这两种手术的时机和适应证不同，两种手术方法围手术期结果的差异尚未得到充分比较。本系统评价和荟萃分析的目的是评估两种手术方法围手术期结果的现有证据，以便更好地影响颅骨缝早闭的治疗模式。
我们遵循推荐的PRISMA系统评价指南。检索了七个电子数据库，以识别从数据库建立至2018年2月发表的所有潜在相关研究，然后根据一组选择标准进行筛选。采用比例荟萃分析对数据进行提取和分析。
12项研究符合所有纳入选择标准，描述了一个包含2064例颅骨缝早闭患者的汇总队列，其中965例（47%）和1099例（53%）患者分别接受了内镜手术和开放手术。与开放手术相比，发现内镜手术在失血量（MD = 162.4 mL）、手术时间（MD = 112.38分钟）、住院时间（MD = 2.56天）以及围手术期并发症发生率（OR = 0.58）、再次手术率（OR = 0.37）和输血率（OR = 0.09）方面均有统计学显著降低，所有p均<0.001。
内镜和开放手术方法均可作为颅骨缝早闭手术治疗的可行选择。与开放手术相比，内镜手术在手术及术后发病率方面有显著降低。鉴于在治疗患者时应考虑每种手术方法的具体适应证，围手术期结果的差异仍是该治疗模式的重要因素。未来的研究将验证本研究的结果并考虑长期结果，这将有助于提高颅骨缝早闭治疗的严谨性。
