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Background: Microsurgery is a treatment option for dural arteriovenous fistula (DAF), but its efficacy is still unclear. This study aims to assess the efficacy and safety of microsurgery for the treatment of patients with DAF. Methods: We will carry out this study assessing the use of microsurgery in patients with DAF from the following electronic databases: PUBMED, EMBASE, Cochrane Library, CINAHL, PsycINFO, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All those databases will be searched from inception to the present without language limitations. Two independent authors will perform study selection, data extraction, and methodological quality assessment. RevMan 5.3 Software will be applied for statistical analysis. Results: This study will assess the efficacy and safety of microsurgery for the treatment of patients with DAF through measuring initial treatment failure, late recurrence, neurological improvement, quality of life, and complications. Conclusion: This study will provide most recent evidence of microsurgery for the treatment of patients with DAF. Dissemination and ethics: The findings of this systematic review will be published in peer-reviewed journals. This systematic review dose not needs ethic approval, because it just analyzes the published data without individual information involvement. Systematic review registration: PROSPERO CRD42019144851. Abbreviations: CI = confidence interval, DAF = dural arteriovenous fistula. Keywords: dural arteriovenous fistula, efficacy, microsurgery, safety, systematic review the fistula. The highest incidence of DAF often occurred in the 1. Introduction cavernous sinus area, accounting for 45.5%, followed by the Dural arteriovenous fistula (DAF) is a very abnormal disorder, areas of transverse sinus-sigmoid sinus, sacral, superior sagittal which directs connections between arteries and veins in the dura [4–7] sinus, anterior cranial fossa, and the posterior fossa. [1] mater. It often occurs at the dura mater and its accessory A variety of clinical trials have reported that microsurgery can tissues, such as the cerebral palsy and cerebellum, accounting for [8–19] help to treat DAF effectively. Its efficacy and complications [2,3] 10% to 15% of intracranial vascular malformations. This are, however, still inconclusive, and no systematic review has condition consists of 5 different types according to the position of investigated this issue. Thus, this study will systematically explore the efficacy and safety of microsurgery for patients with DAF. G-fS and HW contributed equally to this study. This work has supported by the Jiamusi University Foundation Research Project 2. Methods and analysis (No. JMSUJCMS2016-027). The financial supporter will not participate any parts of this study. 2.1. Eligibility criteria The authors report no conflicts of interest. 2.1.1. Participants/population. Patients with DAF, regardless a b Department of Neurosurgery, Department of Neurology, First Affiliated Hospital the sex, age, and race will be included in this study. of Jiamusi University, Jiamusi, Department of Neurosurgery, Beijing Xuanwu 2.1.2. Interventions/exposure. In the experimental group, Hospital, Department of Neurosurgery, Beijing Miyun District Hospital, Beijing, China. patients must receive microsurgery for the treatment. Correspondence: Ming-li Mao, Department of Neurosurgery, Beijing Miyun In the control group, patients, however, can receive any District Hospital, No. 383 Sunshine St, Miyun Dist, Beijing 101500, China treatments, except any types of microsurgery. (e-mail: minglimao@yeah.net). 2.1.3. Study types. All randomized controlled trials assessing Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons the efficacy and safety of microsurgery for the treatment of DAF Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and will be considered for inclusion. reproduction in any medium, provided the original work is properly cited. 2.1.4. Outcome measurements. Outcome measurements con- How to cite this article: Song Gf, Wang H, Li X, He C, Mao Ml. Efficacy of microsurgery for dural arteriovenous fistula. Medicine 2019;98:45(e17288). sist of initial treatment failure, late recurrence, neurological Received: 14 August 2019 / Accepted: 30 August 2019 improvement (as measured by National Institute of Health Stroke Scale score or other related scales), quality of life (as assessed by http://dx.doi.org/10.1097/MD.0000000000017288 1 Song et al. Medicine (2019) 98:45 Medicine 2.5. Dealing with missing data Table 1 Search strategy applied in PUBMED database. If there is insufficient information or unclear data, we will contact original authors to request them. We will analyze the available Number Search terms data if these additional data cannot be achieved and we will 1 Dural arteriovenous fistula discuss its impacts on the results of this study. 2 Central nervous system 3 Vascular malformations 4 Or 1-3 2.6. Risk of bias assessment 5 Microsurgery Two independent authors will utilize Cochrane risk of bias tool to 6 Surgery 7 Operation assess the methodological quality for each eligible study. Any 8 Or 5-7 divergences between 2 authors will be settled down by a third 9 Randomized controlled trials author through discussion. This tool covers 7 domains, and each 10 Random one is further classified as low, unclear, and high risk of bias. 11 Randomly 12 Allocation 2.7. Reporting bias assessment 13 Control 14 Comparator Funnel plot and Egger regression test will be used to assess any 15 Blind possible reporting bias among eligible studies if >10 trials are 16 Clinical trials included. 17 Clinical study 18 Or 9-17 19 4 and 8 and 18 2.8. Assessment of heterogeneity We will use I test to identify heterogeneity among eligible studies. If there is low heterogeneity (I 50%), a fixed-effect 36-Item Short Form Survey or other relevant tools), and model will be applied for data pooling. On the contrary, if there is complications. significant heterogeneity (I > 50%), a random-effect model will be used for data pooling. 2.2. Literature search 2.9. Measurement of treatment effect The current research collects and analyses studies on assessing the efficacy and safety of microsurgery for DAF from We will calculate the continuous data as mean difference or PUBMED, EMBASE, Cochrane Library, CINAHL, PsycINFO, standardized mean difference and 95% confidence intervals Allied and Complementary Medicine Database, Chinese (CIs), and dichotomous data as risk ratio and 95% CIs. Biomedical Literature Database, and China National Knowl- edge Infrastructure. We will search all those databases 2.10. Statistical analysis from inception to the present without language restrictions. We will use RevMan 5.3 software to analyze all outcome data. The example of search strategy for PUBMED is shown in According to the results of heterogeneity, we will pool the data Table 1. We will also apply similar search strategy to any other using a fixed-effect model, and will carry out meta-analysis if I electronic databases. 50%. However, if I >50%, we will pool the data using a In addition, we will search any conference materials, random-effect model and will conduct subgroup analysis at the dissertations, reports, and reference lists of relevant reviews. same time. If there is still substantial heterogeneity after subgroup analysis, we will not perform meta-analysis, but will report 2.3. Data selection outcome results with a narrative summary instead. Two independent authors will scrutinize the titles or abstracts firstly, and any irrelevant and duplicated studies will be excluded. 2.11. Subgroup analysis Secondly, remaining studies will be carefully examined the full Subgroup analysis will be performed based on the different forms texts according to all eligibility criteria. The process of study of treatments, comparators, and outcome measurement tools. selection will be presented in the flowchart in Figure 1. The reason for each study will be excluded at different stages. Any disagreements will be solved through discussion with the help 2.12. Sensitivity analysis of a third author. We will conduct sensitivity analysis to identify the robustness of pooled outcomes by removing studies with high risk of bias. 2.4. Data extraction and management Two authors will independently collect data from all eligible 3. Discussion studies using previous data extracted sheet. Any different opinions between 2 authors will be solved by a third author. DAF is a rare disorder in the clinical practice. Although several The extracted information comprises of characteristics of study studies have reported that microsurgery can help patients with (such as title, author, country, etc), sample size, study design, DAF, no confirmed conclusion is made. Thus, this study firstly study methods, treatment details, outcome measurements, tries to investigate the efficacy and safety of microsurgery for funding, and any other relevant information. patients with DAF. Its results may provide systematic and 2 Song et al. Medicine (2019) 98:45 www.md-journal.com Records identified through Additional records identified through other electronic databases searching sources (n = ) (n = ) Records after duplicates removed (n = ) Records screened Records excluded (n = ) (n = ) Full-text articles Full-text articles assessed for eligibility excluded, with reasons (n = ) (n = ) Studies included in qualitative synthesis (n = ) Studies included in quantitative synthesis (meta-analysis) (n = ) Figure 1. Flowchart of study selection. comprehensive assessment for the efficacy and safety of Resources: Guang-fu Song, He Wang, Chuan He. microsurgery for the patients with DAF. Such study will also Software: He Wang, Xin Li, Chuan He. provide help to make decisions regarding the future practice of Supervision: Ming-li Mao. microsurgery for DAF. Validation: Guang-fu Song, Xin Li, Chuan He, Ming-li Mao. Visualization: Guang-fu Song, He Wang, Ming-li Mao. Writing – original draft: Guang-fu Song, He Wang, Xin Li, Author contributions Chuan He, Ming-li Mao. Conceptualization: Guang-fu Song, Xin Li, Chuan He, Ming-li Writing – review and editing: Guang-fu Song, He Wang, Xin Li, Mao. Chuan He, Ming-li Mao. Data curation: Guang-fu Song, He Wang, Chuan He, Ming-li Mao. References Formal analysis: Guang-fu Song, He Wang, Xin Li. [1] Stiebel-Kalish H, Setton A, Nimii Y, et al. Cavernous sinus dural Funding acquisition: Ming-li Mao. arteriovenous malformations: patterns of venous drainage are related to Investigation: Guang-fu Song, Ming-li Mao. clinical signs and symptoms. Ophthalmology 2002;109:1685–91. Methodology: Guang-fu Song, He Wang, Xin Li, Chuan He. [2] Miller NR. Dural carotid-cavernous fistulas: epidemiology, clinical Project administration: Ming-li Mao. presentation, and management. Neurosurg Clin N Am 2012;23:179–92. Eligibility Included Screening Idenficaon Song et al. Medicine (2019) 98:45 Medicine [3] Colby GP, Coon AL, Huang J, et al. Historical perspective of treatments [11] Niizuma K, Sakata H, Koyama S, et al. Childhood transverse sinus dural of cranial arteriovenous malformations and dural arteriovenous fistulas. arteriovenous fistula treated with endovascular and direct surgery: a case Neurosurg Clin N Am 2012;23:15–25. report. No Shinkei Geka 2012;40:1015–20. [4] Bret P, Salzmann M, Bascoulergue Y, et al. Dural arteriovenous fistula [12] Shen SC, Tsuei YS, Chen WH, et al. Hybrid surgery for dural of the posterior fossa draining into the spinal medullary veins—an arteriovenous fistula in the neurosurgical hybrid operating suite. BMJ unusual cause of myelopathy: case report. Neurosurgery 1994; Case Rep 2014;2014: bcr2013011060. 35:965–9. [13] Shen SC, Tsuei YS, Chen WH, et al. Hybrid surgery for dural [5] Versari PP, D’Aliberti G, Talamonti G, et al. Progressive myelopathy arteriovenous fistula in the neurosurgical hybrid operating suite. 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A case of dural arteriovenous tion and angiographic findings. AJNR Am J Neuroradiol 1996;17: fistula in the anterior cranial fossa that developed remote from the 1549–54. craniotomy site after surgery. No Shinkei Geka 2017;45:519–26. [8] Kawaguchi S, Sakaki T, Morimoto T, et al. Surgery for dural [17] Wu CA, Yang HC, Hu YS, et al. Venous outflow restriction as a predictor arteriovenous fistula in superior sagittal sinus and transverse sigmoid of cavernous sinus dural arteriovenous fistula obliteration after Gamma sinus. J Clin Neurosci 2000;7(suppl 1):47–9. Knife surgery. J Neurosurg 2019;25:1–8. [9] Sheehan J. Gamma knife surgery for dural arteriovenous fistula. J [18] Ozono K, Morofuji Y, Sadakata E, et al. Open surgery following Neurosurg 2006;104:864–5. transarterial embolization for cavernous sinus dural arteriovenous [10] Giller CA, Barnett DW, Thacker IC, et al. Multidisciplinary fistula. No Shinkei Geka 2019;47:435–40. treatment of a large cerebral dural arteriovenous fistula using [19] Yokoyama S, Nakagawa I, Kotsugi M, et al. Dural arteriovenous fistula embolization, surgery, and radiosurgery. Proc (Bayl Univ Med Cent) arising after intracranial surgery in posterior fossa of nondominant sinus: 2008;21:255–7. two cases and literature review. Asian J Neurosurg 2019;14:602–6.
Medicine – Pubmed Central
Published: Nov 11, 2019
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