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Review
. 2023 Nov;29(11):3136-3149.
doi: 10.1111/cns.14347. Epub 2023 Jul 12.

Staged or simultaneous operations for ventriculoperitoneal shunt and cranioplasty: Evidence from a meta-analysis

Jun Zhang  1   2   3   4   5 , Xinyu Deng  1   2   3   4   5 , Qiang Yuan  1   2   3   4   5 , Pengfei Fu  1   2   3   4   5 , Meihua Wang  1   2   6 , Gang Wu  1   2   3   4   5   6 , Lei Yang  1   2   6 , Cong Yuan  1   2   3   4   5 , Zhuoying Du  1   2   3   4   5 , Jin Hu  1   2   3   4   5   6
Affiliations
Review

Staged or simultaneous operations for ventriculoperitoneal shunt and cranioplasty: Evidence from a meta-analysis

Jun Zhang et al. CNS Neurosci Ther. 2023 Nov.

Abstract

Objective: To 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.

Methods: A 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.

Results: Of 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.

Conclusions: Staged 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.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

FIGURE 1
FIGURE 1
Flow diagram for literature search and screening process.
FIGURE 2
FIGURE 2
Forest plot showing comparison of overall infection (A), central nervous system infection (B), cranioplasty infection (C), and shunt infection (D) between simultaneous and staged groups.
FIGURE 3
FIGURE 3
The forest plot displaying a comparison of the risk of reoperation between the two groups.
FIGURE 4
FIGURE 4
Forest plot of meta‐analysis on the occurrence of shunt obstruction risk in both groups.
FIGURE 5
FIGURE 5
Forest plot indicating comparison of epidural hematoma (A), subdural hematoma (B), and intracranial hematoma (C) in simultaneous and staged groups.
FIGURE 6
FIGURE 6
Forest plot of subdural effusion risk between two groups.
FIGURE 7
FIGURE 7
The funnel plots of overall infection (A), central nervous system infection (B), shunt obstruction (C), intracranial hematoma (D), and subdural effusion (E).
See this image and copyright information in PMC

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References

    1. Goodrich JT. How to get in and out of the skull: from tumi to “hammer and chisel” to the Gigli saw and the osteoplastic flap. Neurosurg Focus. 2014;36(4):E6. doi:10.3171/2014.2.FOCUS13543 - DOI - PubMed
    1. Kocher T. Hirnerschütterung, Hirndruck und chirurgische Eingriffe bei Hirnkrankheiten. Alfred Hölder; 1901.
    1. Eberle BM, Schnüriger B, Inaba K, Peter Gruen J, Demetriades D, Belzberg H. Decompressive craniectomy: surgical control of traumatic intracranial hypertension may improve outcome. Injury. 2010;41(9):894‐898. doi:10.1016/j.injury.2010.02.023 - DOI - PubMed
    1. Guresir E, Beck J, Vatter H, et al. Subarachnoid hemorrhage and intracerebral hematoma: incidence, prognostic factors, and outcome. Neurosurgery. 2008;63(6):1088‐1093. doi:10.1227/01.NEU.0000335170.76722.B9 - DOI - PubMed
    1. Guresir E, Raabe A, Setzer M, et al. Decompressive hemicraniectomy in subarachnoid haemorrhage: the influence of infarction, haemorrhage and brain swelling. J Neurol Neurosurg Psychiatry. 2009;80(7):799‐801. doi:10.1136/jnnp.2008.155630 - DOI - PubMed

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