Shunting,optic nerve sheath fenestration and dural venous stenting for medically refractory idiopathic intracranial hypertension:systematic review and meta-analysis  

作　　者：Daniel B.Scherman Adam A.Dmytriw Gia Thanh Nguyen Nhan Thi Nguyen Nana Tchantchaleishvili Julian Maingard Hamed Asadi Mark Brooks Christoph Griessenauer Christopher Ogilvy Ajith J.Thomas Justin M.Moore Kevin Phan 

机构地区：[1]NeuroSpine Surgery Research Group(NSURG),Prince of Wales Private Hospital,Sydney,Australia [2]Department of Neurosurgery,Beth Israel Deaconess Medical Center,Harvard Medical School,Boston,USA [3]Hue University of Medicine and Pharmacy,Hue City,Vietnam [4]University of Medicine and Pharmacy,Ho Chi Minh City,Vietnam [5]Interventional Neuroradiology Service,Department of Radiology,Austin Hospital,Melbourne,Australia [6]Interventional Neuroradiology Unit,Monash Imaging,Monash Health,Melbourne,Australia [7]Faculty of Health,School of Medicine,Deakin University,Waurn Ponds,Australia [8]Department of Neurosurgery,Geisinger Health System,Danville,USA [9]Department of Neurosurgery,Stanford University,Stanford,USA

出　　处：《Annals of Eye Science》2018年第1期169-183,共15页眼科学年鉴（英文）

摘　　要：Background:Cerebrospinal fluid(CSF)-diversion procedures have traditionally been the standard of treatment for patients with medically refractive idiopathic intracranial hypertension(IIH).However,dural venous sinus stent(VSS)placement has been described as a safe and effective procedure for the management of medically refractive IIH.We performed a meta-analysis comparing outcomes and complications of CSF-diversion procedures,VSS and optic nerve sheath fenestration(ONSF)for the treatment of medically refractive IIH.Methods:Electronic searches were performed using six databases from 1988 to January 2017.Data was extracted and meta-analysed from the identified studies.Results:From 55 pooled studies,there were 538 CSF-diversion cases,224 dural venous stent placements,and 872 ONSF procedures.Similar improvements were found in terms of postoperative headaches(CSF vs.VSS vs.ONSF:84%vs.78%vs.62%,P=0.223),papilledema(CSF vs.VSS vs.ONSF:71%vs.86%vs.77%,P=0.192),whilst visual acuity changes favored venous stenting(CSF vs.VSS vs.ONSF:55%vs.69%vs.44%,P=0.037).There was a significantly lower rate of subsequent procedures with venous stent placement(CSF vs.VSS vs.ONSF:37%vs.13%vs.18%,P<0.001),but other complication rates were similar(CSF vs.VSS vs.ONSF:13%vs.8%vs.14%,P=0.28).Subgroup analysis of lumbar-peritoneal vs.ventriculoperitoneal shunts found no differences in symptom improvements,complications and subsequent procedure rates.Conclusions:Our findings suggest that dural venous sinus stenting may be a viable alternative to traditional surgical interventions in patients who are refractory to medical treatment.

关 键 词：Cerebrospinal fluid diversion procedures(CSF-diversion procedures) idiopathic intracranial hypertension(IIH) optic nerve sheath fenestration(ONSF) venous sinus stent placement(VSS) 

分 类 号：R54[医药卫生—心血管疾病]