Mavrovounis Georgios, Kalogeras Adamantios, Brotis Alexandros, Iaccarino Corrado, Demetriades Andreas K, Fountas Konstantinos N
Department of Neurosurgery, Faculty of Medicine, University of Thessaly, Larisa, Greece.
Division of Neurosurgery, Department of Biomedical, Metabolic and Neural Sciences, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy.
Brain Spine. 2021 Oct 22;1:100303. doi: 10.1016/j.bas.2021.100303. eCollection 2021.
There is an ongoing debate whether Decompressive Craniectomy (DC) serves as an independent risk factor for the development of Post-traumatic Hydrocephalus (PTH).
The aim of this systematic review and meta-analysis was to compare the incidence of PTH in TBI patients that underwent DC versus those that were managed without DC.
The literature was systematically reviewed to identify studies with specific inclusion criteria: (1) Randomized Controlled Trials and observational studies with more than 10 patients in each study arm, (2) comparing the incidence of PTH, (3) in patients aged ≥15 years old, (4) that either underwent DC or received other treatment (non-DC). (5) Only studies in English were included and (6) no restrictions were applied on publication date. The pooled Odds Ratio (OR) and Confidence Interval (CI) were calculated. The quality of the included studies was assessed using the ROBINS and RoB 2.0 tools.
Evidence from six articles was synthesized, incorporating data from 2522 patients. A statistically significant higher occurrence of PTH [OR (95% CI): 4.84 (2.51, 9.31); Pz < 0.00001] was identified in patients undergoing DC for TBI when compared to those that were managed without DC. The same was true when only patients with severe TBI were included in the analysis [OR (95% CI): 2.87 (1.85, 4.43); Pz < 0.00001].
Our study has shown, within limitations, a clear association between DC and PTH. Further prospective studies, providing high-quality evidence, are needed to definitively establish any causative relationship between DC and PTH.
关于减压性颅骨切除术（DC）是否是创伤后脑积水（PTH）发生的独立危险因素，目前仍存在争议。
本系统评价和荟萃分析的目的是比较接受DC治疗的创伤性脑损伤（TBI）患者与未接受DC治疗的患者中PTH的发生率。
对文献进行系统回顾，以确定符合特定纳入标准的研究：（1）每个研究组有超过10名患者的随机对照试验和观察性研究；（2）比较PTH的发生率；（3）年龄≥15岁的患者；（4）接受DC治疗或接受其他治疗（非DC）的患者。（5）仅纳入英文研究，（6）对发表日期无限制。计算合并优势比（OR）和置信区间（CI）。使用ROBINS和RoB 2.0工具评估纳入研究的质量。
综合了6篇文章的证据，纳入了2522例患者的数据。与未接受DC治疗的TBI患者相比，接受DC治疗的患者中PTH的发生率在统计学上显著更高[OR（95%CI）：4.84（2.51，9.31）；Pz<0.00001]。当分析仅纳入重度TBI患者时，情况也是如此[OR（95%CI）：2.87（1.85，4.43）；Pz<0.00001]。
我们的研究在一定局限性内表明，DC与PTH之间存在明确关联。需要进一步的前瞻性研究提供高质量证据，以明确确定DC与PTH之间的任何因果关系。
