成人症状性颅内蛛网膜囊肿手术干预效果综述
A Review on the Effectiveness of Surgical Intervention for Symptomatic Intracranial Arachnoid Cysts in Adults.
作者信息
Hayes Madeline J, TerMaath Stephanie C, Crook T Russell, Killeffer James A
机构信息
Department of Chemical and Biomolecular Engineering, University of Tennessee, Knoxville, Knoxville, Tennessee, USA.
Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, Knoxville, Tennessee, USA.
出版信息
World Neurosurg. 2019 Mar;123:e259-e272. doi: 10.1016/j.wneu.2018.11.149. Epub 2018 Nov 26.
BACKGROUND
Intracranial arachnoid cysts are generally benign and can be asymptomatic or symptomatic. When symptoms are indicated, the effects of arachnoid cysts can be disabling to the patient. Quantitative assessment on the effectiveness of surgical intervention to relieve symptoms is inconsistently reported throughout the literature and is often contradictory. Due to this lack of direct evidence and disagreement among practitioners, nonsurgical treatment, such as pain management, is often prescribed. The objectives of this research were to evaluate the effectiveness of the 3 most common surgical treatments (craniotomy, endoscopic fenestration, and shunting) in relieving patient symptoms and to provide a resource of case study information for doctors and patients considering surgical intervention.
METHODS
A worldwide literature review was performed using the PubMed database to collect reported data on case studies describing surgical intervention for intracranial arachnoid cysts. A meta-analytic review was performed on the viable data to investigate the overall surgical effectiveness for an adult population (aged 18 years or older). To increase the number of patient outcomes, some mixed data (case studies containing both adult and pediatric patients) were included in this study.
RESULTS
The meta-analytic results show that, for the mixed adult and pediatric population, surgical treatment improves patient outcomes (r¯ = 0.828; P < 0.01), and the specific effects for craniotomy, shunting, and endoscopy are r¯ = 0.890, 0.738, and 0.892. For the adult-only population, the meta-analytic results show that surgical treatment also improves patient outcomes (r¯ = 0.667; P < 0.01), and the specific effects for craniotomy, shunting, and endoscopy are r¯ 0.638, 0.684, and 0.727.
CONCLUSIONS
The results indicate that surgical intervention is an effective approach to reduce or eliminate symptoms caused by intracranial arachnoid cysts.
背景
颅内蛛网膜囊肿通常为良性，可无症状或有症状。当出现症状时，蛛网膜囊肿的影响可能会使患者致残。关于手术干预缓解症状有效性的定量评估在整个文献中报道不一致，且常常相互矛盾。由于缺乏直接证据以及从业者之间存在分歧，通常会采用非手术治疗，如疼痛管理。本研究的目的是评估三种最常见的手术治疗方法（开颅手术、内镜下开窗术和分流术）缓解患者症状的有效性，并为考虑手术干预的医生和患者提供案例研究信息资源。
方法
使用PubMed数据库进行全球文献综述，以收集描述颅内蛛网膜囊肿手术干预的案例研究报告数据。对可行数据进行荟萃分析，以研究成年人群（18岁及以上）的总体手术有效性。为增加患者结局数量，本研究纳入了一些混合数据（包含成人和儿童患者的案例研究）。
结果
荟萃分析结果表明，对于成人和儿童混合人群，手术治疗可改善患者结局（r¯ = 0.828；P < 0.01），开颅手术、分流术和内镜检查的具体效果分别为r¯ = 0.890、0.738和0.892。对于仅成人人群，荟萃分析结果表明手术治疗也可改善患者结局（r¯ = 0.667；P < 0.01），开颅手术、分流术和内镜检查的具体效果分别为r¯ 0.638、0.684和0.727。
结论
结果表明手术干预是减轻或消除颅内蛛网膜囊肿所致症状的有效方法。
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