Kaufmann Matthew R, Camilon Philip Ryan, Levi Jessica R, Devaiah Anand K
Boston University School of Medicine, Boston, Massachusetts, United States.
Department of Otolaryngology, Boston University, Boston, Massachusetts, United States.
J Neurol Surg B Skull Base. 2021 Apr;82(2):233-243. doi: 10.1055/s-0040-1713105. Epub 2020 Oct 5.
The role of anticoagulation (AC) in the management of otogenic cerebral venous sinus thrombosis (OCVST) remains controversial. Our study aims to better define when AC is used in OCVST. MEDLINE, EMBASE, and The Cochrane Library were searched from inception to February 14, 2019 for English and English-translated articles. References cited in publications meeting search criteria were searched. Titles and abstracts were screened and identified in the literature search, assessing baseline risk of bias on extracted data with the methodological index for nonrandomized studies (MINORS) scale. Random effects meta-regression followed by random forest machine learning analysis across 16 moderator variables between AC and nonanticoagulated (NAC) cohorts was conducted. A total of 92% of treated patients were free of neurologic symptoms at the last follow-up (mean 29.64 months). Four percent of AC and 14% of NAC patients remained symptomatic (mean 18.72 and 47.10 months). 3.5% of AC patients experienced postoperative wound hematomas. AC and NAC recanalization rates were 81% (34/42) and 63% (five-eights), respectively. OCVST was correlated with cholesteatoma and intracranial abscess. Among the analyzed covariates, intracranial abscess was most predictive of AC and cholesteatoma was most predictive of NAC. Comorbid intracranial abscess and cholesteatoma were predictive of AC. The present study is the first to utilize machine learning algorithms in approaching OCVST. Our findings support the therapeutic use of AC in the management of OCVST when complicated by thrombophilia, intracranial abscess, and cholesteatoma. Patients with intracranial abscess and cholesteatoma may benefit from AC and surgery. Patients with cholesteatoma can be managed with NAC and surgery.
抗凝治疗（AC）在耳源性脑静脉窦血栓形成（OCVST）管理中的作用仍存在争议。我们的研究旨在更好地明确OCVST何时使用AC。从创刊至2019年2月14日，检索MEDLINE、EMBASE和Cochrane图书馆，查找英文及英文翻译文章。检索符合搜索标准的出版物中引用的参考文献。在文献检索中筛选标题和摘要，并使用非随机研究方法学指标（MINORS）量表评估提取数据的基线偏倚风险。对AC组和非抗凝（NAC）组之间的16个调节变量进行随机效应元回归，随后进行随机森林机器学习分析。
在最后一次随访时（平均29.64个月），共有92%的接受治疗患者无神经系统症状。4%的AC组患者和14%的NAC组患者仍有症状（平均分别为18.72个月和47.10个月）。3.5%的AC组患者发生术后伤口血肿。AC组和NAC组的再通率分别为81%（34/42）和63%（5/8）。OCVST与胆脂瘤和颅内脓肿相关。在分析的协变量中，颅内脓肿最能预测AC组，胆脂瘤最能预测NAC组。合并颅内脓肿和胆脂瘤可预测AC组。
本研究是首次利用机器学习算法处理OCVST。我们的研究结果支持在OCVST合并血栓形成倾向、颅内脓肿和胆脂瘤时使用AC进行治疗。颅内脓肿和胆脂瘤患者可能从AC和手术中获益。胆脂瘤患者可采用NAC和手术治疗。
