管理成年人未破裂的大脑动脉静脉形形:一个更新的网络元分析
Adam A Dmytriw1,2, Jerry Ku3, Sherief Ghozy4
1Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Neurointervention
|June 20, 2023
概括
对未破裂的大脑动脉静脉形形 (ubAVMs) 的保守管理提供了最低的破裂风险和并发症率. 多模式治疗可能是最好的功能改善,尽管风险更高.
科学领域:
- 神经外科 神经外科
- 干预神经病学 干预神经病学
- 放射学 放射学是一门学科.
背景情况:
- 没有破裂的大脑动脉静脉形形 (ubAVMs) 为神经血管专家提出了复杂的管理决策.
- 最佳的治疗策略需要仔细考虑风险和益处.
研究的目的:
- 进行网络元分析,比较ubAVM的保守管理,栓塞,放射性手术,微手术切除和多模式方法.
- 确定对ubAVMs最有效和最安全的管理策略.
主要方法:
- 按照PRISMA的指导方针,在主要数据库 (Ovid Medline,Embase,Web of Science,Cochrane Library) 中进行了系统的文献搜索.
- 使用R版本4.1.1进行了一项频率网络元分析,以比较各种治疗方式.
- 评估结果包括破裂风险,并发症率,功能改善和死亡率.
主要成果:
- 保守的管理表明破裂风险最低,并发症率最低.
- 多模式治疗在干预措施中显示出最少的整体并发症和最好的功能改善和死亡率.
- 然而,与保守治疗相比,多模式治疗显著增加了破裂风险和整体并发症率.
结论:
- 保守的管理与ubAVMs的破裂风险和并发症率最低相关.
- 在平衡死亡率和功能结果时,多模式方法可能是最佳的,特别是在症状患者中.
- 独立治疗 (微手术,栓塞,放射手术) 显示了与自然史相似的功能和死亡率结果,但并发症率更高.
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