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扩张性脑膜切除术与耐火性脑内高血压的标准去压性脑膜切除术相比:一个系统的审查和元分析

Rachel Saunders¹, Jemima Rees¹, Valentina Di Pietro¹

¹Neuroscience and Ophthalmology, Department of Inflammation and Ageing, Institute of Infection, Inflammation and Immunology, University of Birmingham, Edgbaston, Birmingham, UK.

World neurosurgery

|December 15, 2025

概括

扩展性切除术 (EC) 可能是减压性切除术 (DC) 的可行的替代方案,用于控制内压力,显示出类似的死亡率,但结果有所改善. 然而,EC与更高的重新操作率有关,需要进一步研究.

科学领域:

神经外科神经外科
临界护理医学临界护理医学
手术创新在外科创新.

背景情况:

升高的内压力对死亡率和急性脑损伤后的结果构成重大风险.
减压性脑膜切除术 (DC) 是耐火性脑内高血压的标准手术,但需要随后进行脑膜整形.
扩展性切除术 (EC) 旨在通过部分固定骨来避免造术,但其相对安全性和有效性仍然不清楚.

研究的目的:

系统地审查和比较扩展性切除术 (EC) 与解压性切除术 (DC) 的安全性和有效性.
评估关键结果,包括死亡率,重新手术率和神经恢复 (格拉斯哥结果量表).

主要方法:

按照PRISMA指导方针进行系统审查,包括除审查外的所有研究类型.
基于随机对照试验和病例控制研究的数据进行的元分析.
评估结果:死亡率,急性重新手术率和格拉斯哥结局量表 (GOS).

主要成果:

在EC和DC之间没有观察到死亡率的显著差异.
扩展性切除术 (EC) 显示了改善GOS分数的趋势,可能受到选择偏差的影响.
早期重新操作率的边际增加与EC有关 (风险差异为0.08,p = 0.05).
包含的研究中的偏差风险一般为中度至高.

结论:

现有的证据不足以最终指导关于EC与DC的临床决策.
扩展性切除术 (EC) 在精选患者中显示为DC的替代方案,尽管有可能增加急性重新手术率.
强烈建议进行强大的,充足的随机对照试验,以严格评估扩展性切除术 (EC).

关键词:

解压式骨切除术脑内出血脑内出血内高血压是什么意思内压力内压力恶性中脑动脉梗塞中脑动脉梗塞一次性中风中风中风中风中风创伤性脑损伤是一种创伤性脑损伤

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