Gago Guilherme, Strangio Antonio, de Lima Gibbon Frederico, Comeau Marc-Olivier, Cotrim Gomes Fernando, Champagne Pierre-Olivier
Department of Neurosurgery, CHU de Québec - Université Laval, Québec, QC, Canada.
Department of Postgraduate Program in Medicine: Surgical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
Neurosurg Rev. 2025 Sep 18;48(1):651. doi: 10.1007/s10143-025-03813-6.
The extradural anterior petrosal approach (EAPA) is a surgical technique utilized to access pathologies in the petroclival region and the anterolateral aspect of the brainstem, allowing enhanced visualization and maneuverability. Despite its advantages, the EAPA is associated with significant potential complications that remain a topic of debate within the neurosurgical community. This meta-analysis aims to evaluate the incidence of approach-related complications following EAPA. A systematic literature review was conducted across several databases, including PubMed, Scopus, and Embase. The primary outcome was cerebrospinal fluid (CSF) leak, while secondary outcomes included facial palsy, hearing loss, temporal lobe injury, postoperative seizures, and dry eye. Statistical analysis was performed using RStudio 2024.04.1 + 748. Heterogeneity was assessed using I² statistics. Sensitivity analysis was performed with the leave-one-out test. The risk of bias was assessed using ROBINS-I for non-randomized studies. Publication bias was assessed using a funnel plot and Furuya-Kanamori's Doi plot. Exclusion criteria were cases of intradural anterior petrosal approaches and articles where the data concerning approach-related complications could not be extracted. Our systematic search yielded 1098 articles, of which five met the inclusion criteria, encompassing 404 patients. The overall CSF leak rate was estimated at 3.15% (95% CI: 0.07-8.92), with a lower reoperation rate for CSF leaks at 0.40%. Other complications included temporal lobe injury (1.12%), postoperative seizures (2.42%), approach-related facial palsy (2.23%), and approach-related hearing loss (1.04%). Notably, the incidence of postoperative dry eye was reduced from 6.04 to 2.36% following refinements in surgical practices. The EAPA is a safe procedure with a low complication rate when performed in specialized centers. Outcomes depend on meticulous technique, experienced teams, comprehensive preoperative assessment, and neurophysiological monitoring. This meta-analysis is the first to focus on approach-related complications of EAPA, providing valuable insights to enhance surgical safety and patient care.
硬膜外前岩骨入路（EAPA）是一种用于处理岩斜区和脑干前外侧病变的手术技术，可增强可视化和可操作性。尽管具有优势，但EAPA仍伴有显著的潜在并发症，这在神经外科界仍是一个有争议的话题。本荟萃分析旨在评估EAPA术后与入路相关并发症的发生率。对包括PubMed、Scopus和Embase在内的多个数据库进行了系统的文献综述。主要结局是脑脊液（CSF）漏，次要结局包括面神经麻痹、听力丧失、颞叶损伤、术后癫痫发作和干眼。使用RStudio 2024.04.1 + 748进行统计分析。使用I²统计量评估异质性。采用留一法检验进行敏感性分析。使用ROBINS-I评估非随机研究的偏倚风险。使用漏斗图和古谷金盛的Doi图评估发表偏倚。排除标准为硬膜内前岩骨入路病例以及无法提取与入路相关并发症数据的文章。我们的系统检索共获得1098篇文章，其中5篇符合纳入标准，涵盖404例患者。总体脑脊液漏率估计为3.15%（95%CI：0.07 - 8.92），脑脊液漏再次手术率较低，为0.40%。其他并发症包括颞叶损伤（1.12%）、术后癫痫发作（2.42%）、与入路相关的面神经麻痹（2.23%）和与入路相关的听力丧失（1.04%）。值得注意的是，随着手术操作的改进，术后干眼的发生率从6.04%降至2.36%。在专业中心进行EAPA时，该手术是安全的，并发症发生率较低。手术效果取决于精细的技术、经验丰富的团队、全面的术前评估和神经生理监测。本荟萃分析首次聚焦于EAPA与入路相关的并发症，为提高手术安全性和患者护理提供了有价值的见解。
