The Diagnostic Accuracy of Evoked Potential Monitoring Techniques during Intracranial Aneurysm Surgery for Predicting Postoperative Ischaemic Damage:A Systematic Review and Meta-analysis

摘要

Objective:
　　To investigate the diagnostic accuracy of various evoked potential monitoring techniques in predicting post operative neurological deficit in intracranial aneurysm surgery.
　　Methods:
　　The MEDLINE, Embase and Cochrane databases were searched for English literatures from 31st March, 1983 to 31st March, 2013. Original studies that reported the use of evoked potential monitoring during intracranial aneurysm surgery in predicting post operative neurological damage were selected, and their relevant reference lists were hand searched. Test performance characteristics were summarised using hierarchical summary receiver operating characteristic (ROC) curves and bivariable random-effects models.
　　Results:
　　Thirteen qualifying studies (1597 patients; 1689 aneurysms) from six countries were identified. Eight studies investigated the use of SSEP monitoring technique, five investigated TcMEP and another five investigated DMEP. Bivariable pooled sensitivity and specificity were 48 (95％CI:30.7, 65.0) and 92 (88, 94.4) percent respectively for SSEP, 73 (21.0, 96.7) and 94 (87.1-97.5) percent for TcMEP, and 97 (74.43, 99.99) and 89 (84.0, 94.5) for DcMEP. ROC curve analysis showed that TcMEP had the highest accuracy (area under ROC curve 0.95, 95%CI: 0.93-0.97), followed by DcMEP (0.91, 0.89-0.94) and SSEP (0.88, 0.85-0.91).
　　Conclusion:
　　TcMEP and DMEP have higher diagnostic accuracy than SSEP in predicting post operative neurologic deficit. The type of anaesthetic agent, the use of neuromuscular blocking drugs, and the choice of diagnostic criteria for significant change in cerebral blood flow during aneurysm surgery affects the diagnostic accuracy of evoked potential techniques in predicting post operative neurological damage.

目录

Abbreviations

英文摘要

INTRODUCTION

METHODS

Data Source and Searches

Study Selection

Data Extraction and Quality Assessment

Data Synthesis and Analysis

RESULTS

Characteristics and Methodological Quality of Included Studies

Pooled Results and Hierarchic summary ROC Curve

Subgroup analysis, meta-regression and publication bias

DISCUSSION

CONCLUSION

参考文献

Additional File 1:THE QUADAS TOOL

Additional File 2. Table 1:Covariates assessed in the SSEP monitored studies

Additional File 2. Table 2: Covariates assessed in the TcMEP monitored studies

Additional File 2. Table 3:Covariates assessed in the DMEP monitored studies