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首页> 外文期刊>Journal of neurosurgical sciences >Clivus chordomas: a systematic review and meta-analysis of contemporary surgical management
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Clivus chordomas: a systematic review and meta-analysis of contemporary surgical management

机译：Clivus Chordomas：当代手术管理的系统审查和荟萃分析

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INTRODUCTION: Chordomas are rare bony lesions arising from notochordal remnants. Technical advances in endoscopic surgery have allowed the median endonasal corridor to be used for a larger number of chordoma cases. However, very few studies have critically examined the data in support of the anterior midline approach (AMA), as compared to lateral and posterolateral transcranial corridors EVIDENCE ACQUISITION: A systematic search of the literature was done in March 2016 using EMBASE and PubMed for articles published between January 2006 and March 2016 to identify surgical series of clivus chordomas. Only articles describing chordomas cases arising from the clivus of craniocervical junction were included in the analysis.EVIDENCE SYNTHESIS: Twenty-seven articles were included in this systematic review, amounting to a total of 1050 patients. The weighted mean rate of GTR was 39.9% (range 0-78.3%) in this patient population. The surgical approaches were described in 16 papers, with 6 series reporting on surgeries done exclusively through the midline corridor (116 patients). In the remaining 10 series (495 patients), the AMA was used in a mean of 56.8% of cases. In studies including patients operated solely through an AMA, a higher GTR rate was obtained (60.7% us. 42.0%). Postoperative complications were also different between the two cohorts, with lower cranial nerves deficits and CNS infections but higher incidence of CSF leak in the AMA group than in mixed surgical series. In a weighted mean follow-up time of 52.1 ±21.9 months, recurrences were observed in 38.2% of the total population of patients. Among 423 patients, the weighted 5-year PFS was 49.9± 12.1% and the 5-year OS was 73.9±11.2% (N.=391). A random effects model was performed, combining data from studies reporting recurrence rates in GTR and non-GTR (N.=610), with a total odds ratio of having a recurrence for patients who had GTR vs non-GTR of 0.289 (95CI 0.184-0.453).CONCLUSIONS: In this systematic review and meta-analysis of studies published in the last decade, an estimated 5-year PFS of 49.9% and 5-year OS of 73.9% were obtained. The weighted mean GTR rate in the included study was 39.9%, with a significantly reduced occurrence of recurrence in complete resections. Although anterior midline approaches may allow for higher GTR rates and fewer neurological morbidity than traditional transcranial routes, their impact of long-term survival and disease control remains largely unknown.
机译：简介：Chordomas是诺奇遗留的稀有骨骼病变。内窥镜手术的技术进步使中位数的内和管道用于更大数量的脊索瘤病例。然而，与横向和后外侧经济频道走廊相比，很少有研究批判性地检查了支持前中线方法（AMA）的数据（AMA）的数据，而是使用Embase和Pubmed为文章发表的文章进行了系统搜索2006年1月至2016年3月，识别康里斯克里夫斯克里夫罗马州的手术系列。只有描述了从颅脑交叉区的Clivus引起的Chordomas病例的文章均包含在分析中。优化合成：在该系统审查中包含27篇文章，总共1050名患者。该患者人群中，GTR的加权平均率为39.9％（范围0-78.3％）。在16篇论文中描述了手术方法，6系列报告专门通过中线走廊（116名患者）进行。在剩下的10系列（495名患者）中，AMA的平均案件的均值为56.8％。在包括仅通过AMA操作的患者的研究中，获得了更高的GTR速率（美国60.7％。42.0％）。术后并发症在两个队列之间也不同，具有较低的颅神经缺陷和CNS感染，但AMA组中CSF泄漏的发病率较高，而不是混合手术系列。在52.1±21.9个月的加权平均随访时间，观察到患者总人口的38.2％的复发。在423名患者中，加权5年的PFS为49.9±12.1％，5年的OS为73.9±11.2％（N. = 391）。进行了随机效果模型，将来自研究报告复发率的数据组合在GTR和非GTR（N. = 610）中，其具有额外的患者的总差异比率为GTR与0.289（95CI 0.184 -0.453）.Conclusions：在该系统审查和荟萃分析上，在过去十年发表的研究中，获得了49.9％和5年的5年的5年的PFS 73.9％。附录研究中的加权平均GTR速率为39.9％，在完全切除术中发生复发的发生显着降低。尽管前线中线方法可能允许比传统的经颅途径更高的GTR速率和更少的神经系统发病率，但它们对长期存活和疾病控制的影响仍然很大程度上。

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