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Keyhole endoscópico retrosigmoideo para schwanomas vestibulares: Revisión sistemática y meta-análisis
Resumen
Introducción: El desarrollo de la endoscopia para los schwannomas vestibulares en las últimas décadas ofrece una visión panorámica de las estructuras de esta localización, superior a la visión microscópica.
Objetivo: Especificar el papel del keyhole endoscópico retrosigmoideo en los schwannomas vestibulares.
Método: La búsqueda se desarrolló en Medline. Se utilizaron los siguientes términos en inglés con operadores booleanos: "Vestibular schwannoma" OR "acoustic neurinoma" AND "keyhole approach" OR "endoscopic resection" OR "endoscopy" . Se utilizó restricción de idioma español e inglés. Se excluyeron artículos editoriales, cartas al editor, libros, presentaciones de casos únicos, reseñas, metanálisis y aquellos con método incorrecto; también artículos con especímenes anatómicos. Se utilizó el paquete Major del software Jamovi para realizar un metanálisis de un solo brazo, de la resección total y la función facial posquirúrgica "aceptable", y estimar el efecto general. Se consideró heterogeneidad alta un I 2 superior al 75 %.
Resultados: Se eligieron ocho artículos para el estudio. En el análisis, la resección total se estimó en 0,84 para un valor de p inferior a 0,01. Fue similar en el caso de la preservación de la función facial "aceptable", con 0,77. En un análisis de subgrupos, aquellas series donde los diámetros de la lesión tumoral eran mayores a 3 cm mostraron una menor preservación de la función facial. La preservación anatómica del nervio facial fue inferior al 90 % en dos series.
Conclusiones: El keyhole endoscópico retrosigmoideo es una técnica efectiva y segura en schwannomas vestibulares. Los estudios al respecto revelan un éxito relativo, con tasas aceptables de preservación anatómica y funcional del nervio facial.
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Referencias
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