未破裂脑动静脉畸形的治疗：一项系统评价与荟萃分析
Treatments of unruptured brain arteriovenous malformations: A systematic review and meta-analysis.
作者信息
Liu Renjie, Zhan Yongle, Piao Jianmin, Yang Zhongxi, Wei Yun, Liu Pengcheng, Chen Xuan, Jiang Yu
机构信息
Department of Neurovascular Surgery, The First Bethune Hospital of Jilin University, Changchun 130021, Jilin Province.
Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
出版信息
Medicine (Baltimore). 2021 Jun 25;100(25):e26352. doi: 10.1097/MD.0000000000026352.
BACKGROUND
The best therapeutic option for unruptured brain arteriovenous malformations (bAVMs) patients is disputed.
OBJECTIVE
To assess the occurrence of obliteration and complications of patients with unruptured bAVMs after various treatments.
METHODS
A systematic literature search was performed in PubMed, EMBASE, Web of Science, and so on to identify studies fulfilling predefined inclusion criteria. Baseline, treatment, and outcomes data were extracted for statistical analysis.
RESULTS
We identified 28 eligible studies totaling 5852 patients. The obliteration rates were 98% in microsurgery group (95% confidence interval (CI): 96%-99%, I2 = 74.5%), 97% in surgery group (95%CI: 95%-99%, I2 = 18.3%), 87% in endovascular treatment group (95%CI: 80%-93%, I2 = 0.0%), and 68% in radiosurgery group (95%CI: 66%-69%, I2 = 92.0%). The stroke or death rates were 1% in microsurgery group (95%CI: 0%-2%, I2 = 0.0%), 0% in surgery group (95%CI: 0%-1%, I2 = 0.0%), 4% in endovascular treatment group (95%CI: 0%-8%, I2 = 85.8%), and 3% in radiosurgery group (95%CI: 3%-4%, I2 = 82.9%). In addition, the proportions of hemorrhage were 2% in microsurgery group (95%CI: 1%-4%, I2 = 0.0%), 23% in endovascular treatment group (95%CI: 7%-39%), and 12% in radiosurgery group (95%CI: 12%-13%, I2 = 99.2%). As to neurological deficit, the occurrence was 9% in microsurgery group (95%CI: 6%-11%, I2 = 94.1%), 20% in surgery group (95%CI: 13%-27%, I2 = 0.0%), 14% in endovascular treatment group (95%CI: 10%-18%, I2 = 64.0%), and 8% in radiosurgery group (95%CI: 7%-9%, I2 = 66.6%).
CONCLUSIONS
We found that microsurgery might provide lasting clinical benefits in some unruptured bAVMs patients for its high obliteration rates and low hemorrhage. These findings are helpful to provide a reference basis for neurosurgeons to choose the treatment of patients with unruptured bAVMs.
背景
未破裂脑动静脉畸形（bAVM）患者的最佳治疗方案存在争议。
目的
评估未破裂bAVM患者在接受各种治疗后的闭塞情况及并发症发生情况。
方法
在PubMed、EMBASE、Web of Science等数据库中进行系统文献检索，以确定符合预定义纳入标准的研究。提取基线、治疗及结局数据进行统计分析。
结果
我们纳入了28项符合条件的研究，共5852例患者。显微手术组的闭塞率为98%（95%置信区间（CI）：96%-99%，I² = 74.5%），手术组为97%（95%CI：95%-99%，I² = 18.3%），血管内治疗组为87%（95%CI：80%-93%，I² = 0.0%），放射外科组为68%（95%CI：66%-69%，I² = 92.0%）。显微手术组的卒中或死亡率为1%（95%CI：0%-2%，I² = 0.0%），手术组为0%（95%CI：0%-1%，I² = 0.0%），血管内治疗组为4%（95%CI：0%-8%，I² = 85.8%），放射外科组为3%（95%CI：3%-4%，I² = 82.9%）。此外，显微手术组的出血比例为2%（95%CI：1%-4%，I² = 0.0%），血管内治疗组为23%（95%CI：7%-39%），放射外科组为12%（95%CI：12%-13%，I² = 99.2%）。关于神经功能缺损，显微手术组的发生率为9%（95%CI：6%-11%，I² = 94.1%），手术组为20%（95%CI：13%-27%，I² = 0.0%），血管内治疗组为14%（95%CI：10%-18%，I² = 64.0%），放射外科组为8%（95%CI：7%-9%，I² = 66.6%）。
结论
我们发现，显微手术对于一些未破裂bAVM患者可能因其高闭塞率和低出血率而带来持久的临床益处。这些发现有助于为神经外科医生选择未破裂bAVM患者的治疗方法提供参考依据。
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