Lau Jonathan C, Kosteniuk Suzanne E, Walker Thomas, Iansavichene Alla, Macdonald David R, Megyesi Joseph F
Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada.
Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.
World Neurosurg. 2019 Feb;122:404-414. doi: 10.1016/j.wneu.2018.11.036. Epub 2018 Nov 14.
The use of image guidance (IG) in neurosurgery is ubiquitous, even though evidence from patient outcome data has remained limited to smaller, mostly observational, studies. Ommaya reservoir insertion (ORI) has been available as a treatment option for targeted intraventricular pharmacotherapy since the 1960s, far preceding the modern neuronavigation era. We conducted a systematic review and meta-analysis investigating the impact of IG on surgical outcome from ORI.
A systematic database search of MEDLINE and EMBASE was performed to identify studies on operative outcomes from ORI. Only studies reporting patient demographics and perioperative outcomes (hemorrhage, infection, malposition, malfunction, and mortality) were included. Study quality was assessed via MINORS criteria.
Of the 3560 records screened, 43 studies met study inclusion criteria, for a total of 1995 ORI procedures. Pooled rates of outcome for IG compared with non-IG were 6.4% versus 14.1% for overall complications; 2.0% compared with 2.8% for catheter malfunction; 2.3% compared with 3.3% for catheter malposition; 0.7% compared with 4.5% for early infection; and 0.6% compared with 1.4% for mortality. Postoperative hemorrhage was increased at 3.4% compared with 2.4%. Subgroup analysis revealed a difference in early infection rate between frameless and frame-based IG at 0.0% versus 1.9%. Meta-regression revealed a relationship between publication date and all operative outcomes except for catheter malposition and hemorrhage.
This study offers a historical context on the evolution of the practice of ORI and comprises the largest observational analysis of operative outcomes providing objective support for the use of IG in neurosurgery.
尽管来自患者预后数据的证据仍局限于规模较小且大多为观察性的研究，但图像引导（IG）在神经外科手术中的应用已十分普遍。自20世纪60年代起，远早于现代神经导航时代，奥马亚贮器置入术（ORI）就已作为一种靶向脑室内药物治疗的选择。我们进行了一项系统评价和荟萃分析，以研究IG对ORI手术结局的影响。
对MEDLINE和EMBASE进行系统的数据库检索，以识别关于ORI手术结局的研究。仅纳入报告患者人口统计学和围手术期结局（出血、感染、位置不当、功能故障和死亡率）的研究。通过MINORS标准评估研究质量。
在筛选的3560条记录中，43项研究符合纳入标准，共涉及1995例ORI手术。IG组与非IG组的总体并发症合并发生率分别为6.4%和14.1%；导管功能故障发生率分别为2.0%和2.8%；导管位置不当发生率分别为2.3%和3.3%；早期感染发生率分别为0.7%和4.5%；死亡率分别为0.6%和1.4%。术后出血率有所增加，分别为3.4%和2.4%。亚组分析显示，无框架IG和有框架IG的早期感染率存在差异，分别为0.0%和1.9%。荟萃回归显示，除导管位置不当和出血外，发表日期与所有手术结局之间存在关联。
本研究提供了ORI实践演变的历史背景，并且是对手术结局进行的最大规模观察性分析，为IG在神经外科手术中的应用提供了客观支持。
