Khalil I, Sayad R, Kamal S K, Hussein Z, Allam S, Caprara A L F, Rissardo J P
Faculty of Medicine, Alexandria University, Alexandria, 5372066, Egypt.
Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.
Neurosurg Rev. 2025 Jun 18;48(1):514. doi: 10.1007/s10143-025-03650-7.
Decompressive hemicraniectomy (DC) for malignant ischemic stroke can lead to hydrocephalus (HC). The dynamics of hydrocephalus at the time of subsequent cranioplasty (CP) are not well characterized. We aimed to systematically review and meta-analyze the rates of hydrocephalus and ventriculomegaly before and after CP, shunt dependency, and hydrocephalus resolution in patients who underwent DC for ischemic stroke. Following the PRISMA guidelines, we searched PubMed, Embase, Scopus, Web of Science, and Cochrane Library through January 2025 (registration number CRD420251039185). in studies reporting hydrocephalus in patients undergoing DC followed by CP for ischemic stroke. Inclusion criteria were ≥ 10 patients in the English language. Data on hydrocephalus/ventriculomegaly rates (pre-CP and post-CP), shunt dependency, and resolution were extracted. Study quality was assessed using the MINORS criteria. Random-effects meta-analyses were performed to calculate pooled proportions with 95% confidence intervals (CI). Heterogeneity was assessed using I², and sources were explored using meta-regression and sensitivity analyses. Ten retrospective studies, involving 579 patients, met the inclusion criteria. The study quality was predominantly fair (6/10) or low (3/10). Pooled rates were: pre-CP hydrocephalus 0.40 (95% CI: 0.17–0.65; I²=95.5%), post-CP hydrocephalus 0.46 (0.14–0.79; I²=89.8%), pre-CP ventriculomegaly 0.43 (0.21–0.67; I²=95.5%), and post-CP ventriculomegaly 0.46 (0.14–0.79; I²=89.8%). There was no significant difference between the pre- and post-CP hydrocephalus rates ( = 0.6481). The pooled rate of shunt-dependent hydrocephalus was 0.11 (0.04–0.22; I²=61.4%), and the hydrocephalus resolution rate post-CP was 0.27 (0.07–0.53; I²=68.7%). Significant heterogeneity was observed across most outcomes, and a potential publication bias was detected. The GRADE assessment indicated very low-to low-quality evidence. Radiographic hydrocephalus or ventriculomegaly is common (approximately 40–46%) both before and after cranioplasty in patients treated with DC for ischemic stroke, with no significant change immediately post-CP identified in this analysis. However, clinically significant hydrocephalus requiring shunting occurs less frequently (approximately 11%). The quality of evidence is limited by the retrospective study design and high heterogeneity. High-quality prospective studies with standardized definitions and follow-up are needed to better understand hydrocephalus dynamics and the impact of cranioplasty timing in this population.
The online version contains supplementary material available at 10.1007/s10143-025-03650-7.
用于恶性缺血性中风的减压性颅骨切除术（DC）可导致脑积水（HC）。后续颅骨修补术（CP）时脑积水的动态变化尚未得到充分描述。我们旨在系统回顾和荟萃分析接受DC治疗缺血性中风患者在CP前后的脑积水和脑室扩大发生率、分流依赖性以及脑积水消退情况。按照PRISMA指南，我们检索了截至2025年1月的PubMed、Embase、Scopus、Web of Science和Cochrane图书馆（注册号CRD420251039185）。纳入报告接受DC治疗后行CP的缺血性中风患者脑积水情况的研究。纳入标准为英文研究且患者≥10例。提取关于脑积水/脑室扩大发生率（CP前和CP后）、分流依赖性和消退情况的数据。使用MINORS标准评估研究质量。进行随机效应荟萃分析以计算合并比例及95%置信区间（CI）。使用I²评估异质性，并通过荟萃回归和敏感性分析探索来源。十项回顾性研究，涉及579例患者，符合纳入标准。研究质量大多为中等（6/10）或低（3/10）。合并发生率为：CP前脑积水0.40（95%CI：0.17–0.65；I²=95.5%），CP后脑积水0.46（0.14–0.79；I²=89.8%），CP前脑室扩大0.43（0.21–0.67；I²=95.5%），CP后脑室扩大0.46（0.14–0.79；I²=89.8%）。CP前后脑积水发生率无显著差异（P = 0.6481）。分流依赖性脑积水的合并发生率为0.11（0.04–0.22；I²=61.4%），CP后脑积水消退率为0.27（0.07–0.53；I²=68.7%）。在大多数结果中观察到显著异质性，并检测到潜在的发表偏倚。GRADE评估表明证据质量极低至低。在接受DC治疗缺血性中风的患者中，影像学上的脑积水或脑室扩大在颅骨修补术前后都很常见（约40 - 46%），本分析未发现CP后立即有显著变化。然而，需要分流的具有临床意义的脑积水发生频率较低（约11%）。证据质量受回顾性研究设计和高异质性限制。需要高质量的前瞻性研究，采用标准化定义和随访，以更好地了解该人群中的脑积水动态变化以及颅骨修补术时机的影响。
在线版本包含可在10.1007/s10143-025-03650-7获取的补充材料。
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