O'Neill Brannan E, Godil Jamila, Bowden Stephen G, Nerison Caleb, Mazur-Hart David J, Obayashi James Obi, Uluc Kutluay
Department of Neurological Surgery, Oregon Health and Science University, Portland, United States.
School of Medicine, Western University of Health Sciences College of Osteopathic Medicine of the Pacific Northwest, Lebanon, Oregon, United States.
Surg Neurol Int. 2025 Mar 28;16:114. doi: 10.25259/SNI_771_2024. eCollection 2025.
A substantial proportion of patients who undergo decompressive craniectomy develop hydrocephalus (HCP), necessitating both cranioplasty (CP) and cerebrospinal fluid (CSF) shunting procedures. There is wide variation in the timing and sequence of these operations. We aim to define the complication rates and types of each treatment algorithm in patients requiring both CP and CSF shunting in an effort to identify the optimal sequence of procedures.
A systematic literature review and meta-analysis were performed to assess complication rates for preCP shunting, simultaneous CP-shunting, and post-CP shunting.
There is a significant difference in complication rates between shunt placement before CP (35% demonstrated complications, confidence interval (CI) 95%, 30.9-39.1, simultaneous ventriculoperitoneal shunt (VPS) and CP (30.8%, CI 95%, 28.4-33.3), and shunt post-CP (24.4%, CI 95%, 20.5-28.2), with the shunt post-CP cohort demonstrating the lowest percentage of all complication subtypes. There is a trend toward decreased odds of complication when CP is performed before VPS.
This information should further strengthen existing recommendations that, whenever possible, CP is performed before VPS to potentially allow for CSF dynamics to normalize. The study population does demonstrate heterogeneity. Therefore, considerations should be made based on the clinical picture and a patient's course.
接受减压性颅骨切除术的患者中，很大一部分会发生脑积水（HCP），这就需要进行颅骨成形术（CP）和脑脊液（CSF）分流手术。这些手术的时间安排和顺序差异很大。我们旨在确定在需要同时进行CP和CSF分流的患者中，每种治疗方案的并发症发生率和类型，以便确定最佳的手术顺序。
进行了一项系统的文献综述和荟萃分析，以评估CP前分流、同期CP分流和CP后分流的并发症发生率。
CP前放置分流器的并发症发生率（35%出现并发症，置信区间（CI）95%，30.9 - 39.1）、同期脑室腹腔分流术（VPS）和CP（30.8%，CI 95%，28.4 - 33.3）以及CP后分流（24.4%，CI 95%，20.5 - 28.2）之间存在显著差异，CP后分流队列的所有并发症亚型发生率最低。当在VPS之前进行CP时，并发症发生几率有降低的趋势。
这些信息应进一步强化现有建议，即只要有可能，应在VPS之前进行CP，以使脑脊液动力学有可能恢复正常。研究人群确实显示出异质性。因此，应根据临床表现和患者病程进行考虑。
