Universidade do Estado da Bahia, Bahia, Brazil.
Universidade de Salvador, Bahia, Brazil.
Neurosurg Rev. 2024 Sep 18;47(1):634. doi: 10.1007/s10143-024-02736-y.
Chiari Malformation Type I (CMI) is a prevalent neurosurgical condition characterized by the descent of cerebellar tonsils below the foramen magnum. Surgery, aimed at reducing symptomatology and syrinx size, presents risks, making intraoperative neuromonitoring (IONM) a potentially vital tool. Despite its widespread use in cervical spine surgery, the utility of IONM in CMI surgery remains controversial, with concerns over increased operative time, cost, restricted anesthetic techniques and tongue lacerations. This systematic review and meta-analysis followed the Cochrane Group standards and PRISMA framework. It encompassed an extensive search through PubMed, Embase, and Web of Science up to December 2023, focusing on clinical and surgical outcomes of IONM in CMI surgery. Primary outcomes included the use of various IONM techniques, complication rates, clinical improvement, reoperation, and mortality. The review, registered at PROSPERO (CRD42024498996), included both prospective and retrospective studies, with rigorous selection and data extraction processes. Statistical analysis was conducted using R software. The review included 16 studies, comprising 1358 patients. It revealed that IONM techniques predominantly involved somatosensory evoked potentials (SSEPs), followed by motor evoked potentials (MEPs) and Brainstem auditory evoked potentials (BAEPs). The estimated risk of complications with IONM was 6% (95% CI: 2-11%; I = 89%), lower than previously reported rates without IONM. Notably, the clinical improvement rate post-surgery was high at 99% (95% CI: 98-100%; I = 56%). The analysis also showed lower reoperation rates in surgeries with IONM compared to those without. Interestingly, no mortality was observed in the included studies. This systematic review and meta-analysis indicate that intraoperative neuromonitoring in Chiari I malformation surgery is associated with favorable clinical outcomes, including lower complication and reoperation rates, and high rates of clinical improvement.
颅底凹陷症 I 型（CMI）是一种常见的神经外科疾病，其特征是小脑扁桃体下降至枕骨大孔以下。旨在减轻症状和脊髓空洞大小的手术存在风险，使得术中神经监测（IONM）成为一种潜在的重要工具。尽管 IONM 在颈椎手术中广泛应用，但在 CMI 手术中的效用仍存在争议，主要涉及手术时间延长、成本增加、麻醉技术受限和舌裂伤等问题。本系统评价和荟萃分析遵循 Cochrane 集团标准和 PRISMA 框架。通过对 PubMed、Embase 和 Web of Science 进行广泛搜索，截至 2023 年 12 月，纳入了 IONM 在 CMI 手术中的临床和手术结果的研究。主要结果包括各种 IONM 技术的使用、并发症发生率、临床改善、再次手术和死亡率。该综述在 PROSPERO（CRD42024498996）上进行了注册，包括前瞻性和回顾性研究，采用了严格的选择和数据提取过程。统计分析使用 R 软件进行。该综述共纳入 16 项研究，包括 1358 例患者。结果表明，IONM 技术主要涉及体感诱发电位（SSEPs），其次是运动诱发电位（MEPs）和脑干听觉诱发电位（BAEPs）。IONM 相关并发症的估计风险为 6%（95%CI：2-11%；I=89%），低于未使用 IONM 的报告发生率。值得注意的是，手术后的临床改善率高达 99%（95%CI：98-100%；I=56%）。分析还表明，IONM 组的再次手术率低于无 IONM 组。有趣的是，纳入的研究中没有观察到死亡。本系统评价和荟萃分析表明，CMI 畸形手术中的术中神经监测与良好的临床结果相关，包括较低的并发症和再次手术率，以及较高的临床改善率。
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