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Staged or simultaneous operations for ventriculoperitoneal shunt and cranioplasty: Evidence from a meta-analysis |
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| Authors: | Jun Zhang Xinyu Deng Qiang Yuan Pengfei Fu Meihua Wang Gang Wu Lei Yang Cong Yuan Zhuoying Du Jin Hu |
| Institution: | 1. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China;2. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
National Center for Neurological Disorders, Shanghai, China Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China Neurosurgical Institute of Fudan University, Shanghai, China Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China;3. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China National Center for Neurological Disorders, Shanghai, China Department of Neurosurgery & Neurocritical Care, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China;4. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China National Center for Neurological Disorders, Shanghai, China Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China Neurosurgical Institute of Fudan University, Shanghai, China Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China Department of Neurosurgery & Neurocritical Care, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China |
| Abstract: | ObjectiveTo date, there is no consensus on the surgery strategies of cranioplasty (CP) and ventriculoperitoneal shunt (VPS) placement. This meta-analysis aimed to investigate the safety of staged and simultaneous operation in patients with comorbid cranial defects with hydrocephalus to inform future surgery protocols.MethodsA meta-analysis of PubMed, Ovid, Web of Science, and Cochrane Library databases from the inception dates to February 8, 2023 adherent to PRISMA guidelines was conducted. The pooled analyses were conducted using RevMan 5.3 software. The outcomes included postoperative infection, reoperation, shunt obstruction, hematoma, and subdural effusion.ResultsOf the 956 studies initially retrieved, 10 articles encompassing 515 patients were included. Among the total patients, 193 (37.48%) and 322 (62.52%), respectively, underwent simultaneous and staged surgeries. The finding of pooled analysis indicated that staged surgery was associated with lower rate of subdural effusion (14% in the simultaneous groups vs. 5.4% in the staged groups; OR = 2.39, 95% CI: 1.04–5.49, p = 0.04). However, there were no significant differences in overall infection (OR = 1.92, 95% CI: 0.74–4.97, p = 0.18), central nervous system infection (OR = 1.50, 95% CI: 0.68–3.31, p = 0.31), cranioplasty infection (OR = 1.58, 95% CI: 0.50–5.00, p = 0.44), shunt infection (OR = 1.30, 95% CI: 0.38–4.52, p = 0.67), reoperation (OR = 1.51, 95% CI: 0.38–6.00, p = 0.55), shunt obstruction (OR = 0.73, 95% CI: 0.25–2.16, p = 0.57), epidural hematoma (OR = 2.20, 95% CI: 0.62–7.86, p = 0.22), subdural hematoma (OR = 1.20, 95% CI: 0.10–14.19, p = 0.88), and intracranial hematoma (OR = 1.31, 95% CI: 0.42–4.07, p = 0.64). Moreover, subgroup analysis failed to yield new insights.ConclusionsStaged surgery is associated with a lower rate of postoperative subdural effusion. However, from the evidence of sensitivity analysis, this result is not stable. Therefore, our conclusion should be viewed with caution, and neurosurgeons in practice should make individualized decisions based on each patient's condition and cerebrospinal fluid tap test. |
| Keywords: | complications craniectomy cranioplasty hydrocephalus ventriculoperitoneal shunt |