Comparison of Postoperative Complications between Simultaneous and Staged Surgery in Cranioplasty and Ventriculoperitoneal Shunt Placement after Decompressive Craniectomy

Gill, Jong Han; Choi, Hye Sook; Lee, Shin Heon; Jang, Kyoung Min; Nam, Taek Kyun; Park, Yong Sook; Kwon, Jeong Taik

doi:10.13004/kjnt.2021.17.e20

Cited by 4 publications

(23 citation statements)

References 21 publications

(23 reference statements)

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“…The two repeated studies and two studies with non‐target outcome indicators were excluded. Finally, 10 articles met our inclusion criteria and were included in the pooled analysis 28–37 . These articles provided data on patient recruitment criteria and outcome variables, allowing us to conduct a thorough analysis of the available evidence.…”

Section: Resultsmentioning

confidence: 99%

“…Recent studies suggested that simultaneous surgery had higher rate of postoperative complications, especially infections, compared with staged surgery. [28][29][30][31] However, some neurosurgery experts indicated that simultaneous CP and VPS placement may be reduce surgical procedures, potential risks associated with general anesthesia, length of stay, medical expenses, and several clinical studies also indicated that there were no significant difference in the incidence of postoperative adverse events between staged and simultaneous surgery. [32][33][34][35][36][37] Given the preceding facts, we conducted a meta-analysis on the clinical research data published on CP and VPS placement in patients with cranial defect comorbid with hydrocephalus and the aimed to investigate the ideal surgical protocol (staged or simultaneous) by comparing the incidence of postoperative complications, including infection, reoperation, shunt obstruction, hematoma, and subdural effusion.…”

Section: Introductionmentioning

confidence: 99%

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Staged or simultaneous operations for ventriculoperitoneal shunt and cranioplasty: Evidence from a meta‐analysis

et al. 2023

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ObjectiveTo date, there is no consensus on the surgery strategies of cranioplasty (CP) and ventriculoperitoneal shunt (VPS) placement. This meta‐analysis aimed to investigate the safety of staged and simultaneous operation in patients with comorbid cranial defects with hydrocephalus to inform future surgery protocols.MethodsA meta‐analysis of PubMed, Ovid, Web of Science, and Cochrane Library databases from the inception dates to February 8, 2023 adherent to PRISMA guidelines was conducted. The pooled analyses were conducted using RevMan 5.3 software. The outcomes included postoperative infection, reoperation, shunt obstruction, hematoma, and subdural effusion.ResultsOf the 956 studies initially retrieved, 10 articles encompassing 515 patients were included. Among the total patients, 193 (37.48%) and 322 (62.52%), respectively, underwent simultaneous and staged surgeries. The finding of pooled analysis indicated that staged surgery was associated with lower rate of subdural effusion (14% in the simultaneous groups vs. 5.4% in the staged groups; OR = 2.39, 95% CI: 1.04–5.49, p = 0.04). However, there were no significant differences in overall infection (OR = 1.92, 95% CI: 0.74–4.97, p = 0.18), central nervous system infection (OR = 1.50, 95% CI: 0.68–3.31, p = 0.31), cranioplasty infection (OR = 1.58, 95% CI: 0.50–5.00, p = 0.44), shunt infection (OR = 1.30, 95% CI: 0.38–4.52, p = 0.67), reoperation (OR = 1.51, 95% CI: 0.38–6.00, p = 0.55), shunt obstruction (OR = 0.73, 95% CI: 0.25–2.16, p = 0.57), epidural hematoma (OR = 2.20, 95% CI: 0.62–7.86, p = 0.22), subdural hematoma (OR = 1.20, 95% CI: 0.10–14.19, p = 0.88), and intracranial hematoma (OR = 1.31, 95% CI: 0.42–4.07, p = 0.64). Moreover, subgroup analysis failed to yield new insights.ConclusionsStaged surgery is associated with a lower rate of postoperative subdural effusion. However, from the evidence of sensitivity analysis, this result is not stable. Therefore, our conclusion should be viewed with caution, and neurosurgeons in practice should make individualized decisions based on each patient's condition and cerebrospinal fluid tap test.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Staged or simultaneous operations for ventriculoperitoneal shunt and cranioplasty: Evidence from a meta‐analysis

et al. 2023

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“…Except for the fact that the existing complications were not included, the reason may be that 29 patients in the observation group only received CP but not VPS, which reduced the number of operations. Secondly, the complications of staged operations were less than those of simultaneous operations ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

“…For example, studies have suggested simultaneous VPS and CP to improved clinical outcomes, shorter hospital stays, and lower medical costs ( 26 ). However, some researchers believe that staged surgery can reduce the single operation time, thereby reducing the risk of surgical complications such as infection ( 11 , 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…Current studies have shown that Simultaneous or staged CP and VPS have different advantages and disadvantages. However, there is still disagreement regarding whether to give CP or VPS precedence in staged surgery ( 11 – 13 ). However, clinical practice has proven that hydrocephalus disappears in some patients after CP, and VPS can be avoided in the later stage ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

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The compensatory mechanism and clinical significance of hydrocephalus after cranioplasty

Qiu

Wang²,

Chen³

et al. 2023

Front. Neurol.

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ObjectiveCranioplasty (CP) and ventriculoperitoneal shunt (VPS) are procedures required after decompression of the flap (DC) to protect the cranial frame and prevent hydrocephalus. This study evaluated the safety and efficacy of different surgical sequences of CP and VPS after DC and identified risk factors for necessary permanent VPS.MethodsFrom January 2017 to December 2021, valid follow-up data were collected in 192 cases. The observation group preferred CP, and then evaluated whether to receive VPS according to the progress of hydrocephalus. the control group was prioritized for VPS and continued with CP after 1 week. The improvement of hydrocephalus symptoms, follow-up outcomes, and post-operative complications before and after surgery were compared between the two groups, and univariate analysis was used to determine the risk factors for necessary permanent risk factors for VPS.ResultsThere were 86 cases (44.8%) in the observation group, who received CP first, while 106 cases (55.2%) in the control group received VPS and CP, respectively. There was no significant difference between the two groups according to Barthel index, FMAS, Mrs, GCS, and Evans index, and there was no statistical difference in complications between the two groups. However, in the observation group, hydrocephalus disappeared after CP operation in 29 cases (33.7%), and finally avoided VPS. Univariate analysis showed that the main etiology was related to the size of the skull defect, the distance of the talus margin relative to the flap to the midline, and lumbar puncture pressure was a predictor of the need for permanent VPS.ConclusionThis study provides detailed information on the efficacy and complications of different sequences of preferential CP or VPS after DC surgery. We found that priority CP reduced the incidence of VPS surgery without affecting surgical outcomes and complications.

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Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel

Iaccarino,

Chibbaro,

Sauvigny

et al. 2024

Brain and Spine

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Comparison of Postoperative Complications between Simultaneous and Staged Surgery in Cranioplasty and Ventriculoperitoneal Shunt Placement after Decompressive Craniectomy

Cited by 4 publications

References 21 publications

Staged or simultaneous operations for ventriculoperitoneal shunt and cranioplasty: Evidence from a meta‐analysis

Staged or simultaneous operations for ventriculoperitoneal shunt and cranioplasty: Evidence from a meta‐analysis

The compensatory mechanism and clinical significance of hydrocephalus after cranioplasty

Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel

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