School of Surgery and Medicine, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.
Department of Surgical Specialities, Neurosurgery Teaching and Assistance Unit, Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil.
Neurosurg Rev. 2024 May 11;47(1):215. doi: 10.1007/s10143-024-02450-9.
Cerebral aneurysms in complex anatomical locations and intraoperative rupture can be challenging. Many methods to reduce blood flow can facilitate its exclusion from the circulation. This study evaluated the safety and efficacy of using adenosine, rapid ventricular pacing, and hypothermia in cerebral aneurysm clipping.
Databases (PubMed, Embase, and Web of Science) were systematically searched for studies documenting the use of adenosine, rapid ventricular pacing, and hypothermia in cerebral aneurysm clipping and were included in this single-arm meta-analysis. The primary outcome was 30-day mortality. Secondary outcomes included neurological outcomes by mRs and GOS, and cardiac outcomes. We evaluated the risk of bias using ROBIN-I, a tool developed by the Cochrane Collaboration. OpenMetaAnalyst version 2.0 was used for statistical analysis and I2 measured data heterogeneity. Heterogeneity was defined as an I > 50%.
Our systematic search yielded 10,100 results. After the removal of duplicates and exclusion by title and abstract, 64 studies were considered for full review, of which 29 were included. The overall risk of bias was moderate. The pooled proportions of the adenosine analysis for the different outcomes were: For the primary outcome: 11,9%; for perioperative arrhythmia: 0,19%; for postoperative arrhythmia: 0,56%; for myocardial infarction incidence: 0,01%; for follow-up good recovery (mRs 0-2): 88%; and for neurological deficit:14.1%. In the rapid ventricular pacing analysis, incidences were as follows: peri operative arrhythmia: 0,64%; postoperative arrhythmia: 0,3%; myocardial infarction: 0%. In the hypothermia analysis, the pooled proportion of 30-day mortality was 11,6%. The incidence of post-op neurological deficits was 35,4% and good recovery under neurological analysis by GOS was present in 69.2%.
The use of the three methods is safe and the related complications were very low. Further studies are necessary, especially with comparative analysis, for extended knowledge.
位于复杂解剖部位的颅内动脉瘤以及术中破裂可能极具挑战性。许多减少血流的方法可以使其从循环中排除。本研究评估了在颅内动脉瘤夹闭术中使用腺苷、快速心室起搏和低温的安全性和有效性。
系统地在数据库（PubMed、Embase 和 Web of Science）中搜索记录了在颅内动脉瘤夹闭术中使用腺苷、快速心室起搏和低温的研究，并将其纳入本单臂荟萃分析。主要结局为 30 天死亡率。次要结局包括 mRs 和 GOS 评估的神经功能结局和心脏结局。我们使用由 Cochrane 合作组织开发的 ROBIN-I 工具评估偏倚风险。使用 OpenMetaAnalyst 版本 2.0 进行统计分析和 I2 测量数据异质性。异质性定义为 I>50%。
我们的系统搜索产生了 10100 个结果。去除重复项并根据标题和摘要排除后，考虑进行完整审查的研究有 64 项，其中 29 项被纳入。总体偏倚风险为中度。腺苷分析的不同结局的汇总比例为：主要结局：11.9%；围手术期心律失常：0.19%；术后心律失常：0.56%；心肌梗死发生率：0.01%；随访时良好恢复（mRs 0-2）：88%；神经功能缺损：14.1%。在快速心室起搏分析中，发生率如下：围手术期心律失常：0.64%；术后心律失常：0.3%；心肌梗死：0%。在低温分析中，30 天死亡率的汇总比例为 11.6%。术后神经功能缺损的发生率为 35.4%，根据 GOS 进行的神经分析中良好恢复率为 69.2%。
三种方法的使用是安全的，相关并发症发生率非常低。需要进一步的研究，特别是具有比较分析的研究，以扩展知识。
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