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Characteristics and management of hydrocephalus associated with vestibular schwannomas: a systematic review.
Neurosurgical Review ( IF 2.5 ) Pub Date : 2020-04-07 , DOI: 10.1007/s10143-020-01287-2
Paolo di Russo 1 , Arianna Fava 1 , Alberto Vandenbulcke 1 , Akinori Miyakoshi 2 , Michihiro Kohno 3 , Alexander I Evins 4 , Vincenzo Esposito 1, 5 , Roberta Morace 1
Affiliation  

Hydrocephalus (HC) can be associated with vestibular schwannoma (VS) at presentation. Although spontaneous resolution of HC after VS removal is reported, first-line treatment is varied including preoperative ventriculoperitoneal (VP) shunt, external ventricular drainage (EVD), or lumbar drainage (LD). We performed a systematic review to clarify optimal management of HC associated with VS at presentation, as well as characteristics of patients with initial and persistent HC after VS removal, and prevalence of HC associated with VS. Fourteen studies were included. Patients were grouped according to the timing of HC treatment. The overall rate of VP shunts was 19.4%. Among patients who received VS removal as first-line treatment, 6.9% underwent permanent shunts. In a subgroup of 132 patients (studies with no-aggregate data), t test analysis for mean tumor size (P = 0.02) and mean CSF protein level (P < 0.001) demonstrated statistically significant differences between patients with resolved HC (3.48 cm and 201 mg/dL) and patients with persistent HC (2.46 cm and 76.8 mg/dL) after VS resection. Transient treatment of HC using EVD or LD further resolved the HC in 87.5% and 82.9% of patients, respectively, before and after VS removal. The overall prevalence of HC associated with VS in a population of 2336 patients was 9.3%. Schwannoma removal as first-line treatment is justified by its low rate of persistent HC requiring VP shunt (roughly 7%). Patients with smaller VS and lower CSF proteins present higher risk of persistent HC after schwannoma removal. Temporary treatment of HC contributes to its resolution, both before and after VS removal.

中文翻译:

与前庭神经鞘瘤相关的脑积水的特征和处理:系统评价。

出现脑积水(HC)可与前庭神经鞘瘤(VS)相关。尽管有报道称去除VS后会自发分离HC,但一线治疗的方法有所不同,包括术前室腹膜腔(VP)分流,外部心室引流(EVD)或腰椎引流(LD)。我们进行了系统的综述,以阐明与VS相关的HC的最佳管理,以及在VS去除后初发和持续性HC患者的特征以及与VS相关的HC的患病率。包括十四项研究。根据HC治疗的时间对患者进行分组。VP分流的总率为19.4%。一线接受VS切除的患者中,有6.9%进行了永久性分流。在132位患者的亚组中(无汇总数据的研究),t检验的平均肿瘤大小(P = 0.02)和平均CSF蛋白水平(P <0.001)分析显示,已分离HC(3.48 cm和201 mg / dL)的患者与持续HC(2.46 cm和76.8)的患者之间存在统计学差异VS切除后)。使用EVD或LD进行的HC短暂治疗,分别在VS去除之前和之后分别使87.5%和82.9%的患者的HC得以解决。在2336名患者中,与VS相关的HC总体患病率为9.3%。除去神经鞘瘤作为一线治疗的理由是其持续性HC率低,需要VP分流(大约7%)。较小的VS和较低CSF蛋白的患者在去除神经鞘瘤后出现持续性HC的风险更高。在VS去除之前和之后,HC的临时治疗有助于其分解。02)和平均CSF蛋白水平(P <0.001)在VS切除后,分辨为HC(3.48 cm和201 mg / dL)的患者与持续性HC(2.46 cm和76.8 mg / dL)的患者之间具有统计学显着差异。使用EVD或LD进行的HC短暂治疗,分别在VS去除之前和之后分别使87.5%和82.9%的患者的HC得以解决。在2336名患者中,与VS相关的HC总体患病率为9.3%。除去神经鞘瘤作为一线治疗的理由是其持续性HC率低,需要VP分流(大约7%)。较小的VS和较低CSF蛋白的患者在去除神经鞘瘤后出现持续性HC的风险更高。在VS去除之前和之后,HC的临时治疗有助于其分解。02)和平均CSF蛋白水平(P <0.001)在VS切除后,分辨为HC(3.48 cm和201 mg / dL)的患者与持续性HC(2.46 cm和76.8 mg / dL)的患者之间具有统计学显着差异。使用EVD或LD进行的HC短暂治疗,分别在VS去除之前和之后分别使87.5%和82.9%的患者的HC得以解决。在2336名患者中,与VS相关的HC总体患病率为9.3%。除去神经鞘瘤作为一线治疗的理由是其持续性HC率低,需要VP分流(大约7%)。较小的VS和较低CSF蛋白的患者在去除神经鞘瘤后出现持续性HC的风险更高。在VS去除之前和之后,HC的临时治疗有助于其分解。001)在VS切除后,已解决的HC患者(3.48 cm和201 mg / dL)与持续性HC患者(2.46 cm和76.8 mg / dL)之间存在统计学差异。使用EVD或LD进行的HC短暂治疗,分别在VS去除之前和之后分别使87.5%和82.9%的患者的HC得以解决。在2336名患者中,与VS相关的HC总体患病率为9.3%。除去神经鞘瘤作为一线治疗的理由是其持续性HC率低,需要VP分流(大约7%)。较小的VS和较低CSF蛋白的患者在去除神经鞘瘤后出现持续性HC的风险更高。在VS去除之前和之后,HC的临时治疗有助于其分解。001)在VS切除后,已解决的HC患者(3.48 cm和201 mg / dL)与持续性HC患者(2.46 cm和76.8 mg / dL)之间存在统计学差异。使用EVD或LD进行的HC短暂治疗,分别在VS去除之前和之后分别使87.5%和82.9%的患者的HC得以解决。在2336名患者中,与VS相关的HC总体患病率为9.3%。除去神经鞘瘤作为一线治疗的理由是其持续性HC率低,需要VP分流(大约7%)。较小的VS和较低CSF蛋白的患者在去除神经鞘瘤后出现持续性HC的风险更高。在VS去除之前和之后,HC的临时治疗有助于其分解。VS切除后46 cm和76.8 mg / dL)。使用EVD或LD进行的HC短暂治疗,分别在VS去除之前和之后分别使87.5%和82.9%的患者的HC得以解决。在2336名患者中,与VS相关的HC总体患病率为9.3%。除去神经鞘瘤作为一线治疗的理由是其持续性HC率低,需要VP分流(大约7%)。VS较小且CSF蛋白较低的患者在去除神经鞘瘤后出现持续性HC的风险更高。在VS去除之前和之后,HC的临时治疗有助于其分解。VS切除后46 cm和76.8 mg / dL)。使用EVD或LD进行的HC短暂治疗,分别在VS去除之前和之后分别使87.5%和82.9%的患者的HC得以解决。在2336名患者中,与VS相关的HC总体患病率为9.3%。除去神经鞘瘤作为一线治疗的理由是其持续性HC率低,需要VP分流(大约7%)。较小的VS和较低CSF蛋白的患者在去除神经鞘瘤后出现持续性HC的风险更高。在VS去除之前和之后,HC的临时治疗有助于其分解。3%。除去神经鞘瘤作为一线治疗的理由是其持续性HC率低,需要VP分流(大约7%)。较小的VS和较低CSF蛋白的患者在去除神经鞘瘤后出现持续性HC的风险更高。在VS去除之前和之后,HC的临时治疗有助于其分解。3%。除去神经鞘瘤作为一线治疗的理由是其持续性HC率低,需要VP分流(约7%)。较小的VS和较低CSF蛋白的患者在去除神经鞘瘤后出现持续性HC的风险更高。在VS去除之前和之后,HC的临时治疗有助于其分解。
更新日期:2020-04-22
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