Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy.
Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II" University of Naples, Naples, Italy.
Childs Nerv Syst. 2022 Jun;38(6):1069-1076. doi: 10.1007/s00381-022-05547-y. Epub 2022 May 3.
Cerebrospinal fluid (CSF) diversion for the treatment of hydrocephalus is one of the most common neurosurgical procedures. Over the years, the development of the neuronavigation system has allowed the surgeon to be guided in real time during the procedures. Nevertheless, to date, the revision rate remains as high as 30-40%. The aim of this study was to investigate the role of intraoperative image guidance in the prevention of shunt failure. We herein report the first literature meta-analysis of image guidance and shunt revision rate in the pediatric population.
Principal online databases were searched for English-language articles published between January, 1980, and December, 2021. Analysis was limited to articles that included patients younger than 18 years of age at the time of primary V-P shunt. Articles reporting combined results of free-hand and image-guided placement of ventricular catheter (VC) were included. The main outcome measure of the study was the revision rate in relation to the intraoperative tools. Secondary variables collected were the age of the patient and ventricle size. Statistical analyses and meta-analysis plots were done via R and RStudio. Heterogeneity was formally assessed using Q, I, and τ statistics. To examine publication bias was performed a funnel plot analysis.
A total of 9 studies involving 2017 pediatric patients were included in the meta-analysis. 55.9% of procedures were carried out with the aid of intraoperative tools, while 44.1% procedures were conducted free hand. The intraoperative tools used were ultrasound (9.1%), electromagnetic neuronavigation (21.07%), endoscope (67.32%), and combined images (2.4%).The image-guided placement of VC was not statistically associated with a lower revision rate. The pooled OR was 0.97 [CI 95% 0.88-1.07] with an I statistics of 34%, t of 0.018 and a p-value of 0.15 at heterogeneity analysis.
Our analysis suggest images guidance during VC shunt placement does not statistically affect shunt survival. Nevertheless, intraoperative tools can support the surgeon especially in patients with difficult anatomy, slit ventricles or complex loculated hydrocephalus.
脑脊液（CSF）分流术是治疗脑积水最常见的神经外科手术之一。多年来，神经导航系统的发展使外科医生能够在手术过程中实时获得指导。然而，迄今为止，返修率仍高达 30-40%。本研究旨在探讨术中影像引导在预防分流失败中的作用。我们在此报告了首次对儿童人群中影像引导与分流器返修率的文献荟萃分析。
主要在线数据库搜索了 1980 年 1 月至 2021 年 12 月间发表的英文文章。分析仅限于主要脑室-腹膜分流术时年龄小于 18 岁的患者的文章。纳入了报告徒手和影像引导下放置脑室导管（VC）结果的文章。本研究的主要观察指标是与术中工具相关的返修率。收集的次要变量包括患者年龄和脑室大小。通过 R 和 RStudio 进行统计分析和荟萃分析图。使用 Q、I 和τ统计量正式评估异质性。通过漏斗图分析检查发表偏倚。
荟萃分析共纳入了 9 项涉及 2017 名儿科患者的研究。55.9%的手术是在术中工具的辅助下进行的，而 44.1%的手术是徒手进行的。术中使用的工具包括超声（9.1%）、电磁神经导航（21.07%）、内镜（67.32%）和组合影像（2.4%）。VC 的影像引导放置与较低的返修率无统计学关联。汇总的优势比（OR）为 0.97[95%置信区间（CI）为 0.88-1.07]，I 统计量为 34%，t 值为 0.018，p 值为 0.15。
我们的分析表明，在 VC 分流器放置过程中进行影像引导不会对分流器的存活产生统计学影响。然而，术中工具可以为外科医生提供支持，尤其是在存在解剖结构困难、狭缝脑室或复杂局限性脑积水的患者中。
