Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, Illinois, USA.
Department of Neurosurgery, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA.
World Neurosurg. 2022 Nov;167:e10-e18. doi: 10.1016/j.wneu.2022.05.057. Epub 2022 May 25.
Ventriculoperitoneal shunt placement is the mainstay of treatment for hydrocephalus, but there are relatively high rates of malfunction. Shunt catheter entry can be performed anteriorly or posteriorly, with the body of evidence from randomized controlled trials and retrospective studies suggesting conflicting findings.
A systematic review of PubMed, Medline, Scopus, and Web of Science was performed adherent to PRISMA guidelines, searching for clinical studies examining outcomes for anterior or frontal and posterior or occipital ventriculoperitoneal shunt placement. A random-effects model meta-analysis was performed on R.
Six studies (2 randomized controlled trials and 4 retrospective cohort studies) comprising 1808 patients were identified. There were no statistically significant differences between anterior and posterior ventriculoperitoneal shunt placement for the outcomes of poor catheter placement (odds ratio [OR], 0.74; P = 0.6) and shunt infections (OR, 1.01; P = 0.9). Posterior shunts trended toward greater number of shunt revisions (OR, 0.72; P = 0.06). Six and 12 months shunt survival was comparable between anterior and posterior approaches (P > 0.05). There were significant differences between long-term shunt survival (2 and 5 years shunt survival), favoring anterior shunt placement with greater odds of survival (OR, 1.91 and OR, 1.62, respectively; P < 0.05).
We show that although anteriorly and posteriorly placed shunts have mostly comparable outcomes, shunt survival at 2-year and 5-year intervals favors anteriorly placed shunts. Additional well-designed clinical trials are needed to validate the findings of greater late shunt failure in posteriorly placed shunts, with more time-dependent statistical measures.
脑室-腹腔分流术是治疗脑积水的主要方法，但存在较高的故障发生率。分流管进入可以从前部或后部进行，随机对照试验和回顾性研究的证据体表明存在相互矛盾的发现。
我们按照 PRISMA 指南对 PubMed、Medline、Scopus 和 Web of Science 进行了系统回顾，搜索了检查前部或额部和后部或枕部脑室-腹腔分流放置的结果的临床研究。我们在 R 上进行了随机效应模型荟萃分析。
确定了 6 项研究（2 项随机对照试验和 4 项回顾性队列研究），共 1808 例患者。在前部和后部脑室-腹腔分流放置的结果中，导管位置不良（比值比 [OR]，0.74；P = 0.6）和分流感染（OR，1.01；P = 0.9）之间没有统计学显著差异。后部分流器有更多的分流器修订（OR，0.72；P = 0.06）。6 个月和 12 个月的分流器存活率在前后入路之间具有可比性（P > 0.05）。长期分流器存活率（2 年和 5 年的分流器存活率）之间存在显著差异，有利于前部分流器，具有更高的生存机会（OR，1.91 和 OR，1.62，分别；P < 0.05）。
尽管前向和后向放置的分流器具有相似的结果，但 2 年和 5 年的分流器存活率有利于前向放置的分流器。需要更多设计良好的临床试验来验证后部放置的分流器后期分流失败的可能性更大的发现，并使用更依赖时间的统计措施。
