Abstract：
OBJECTIVE: Approximately 70%-80% of children born with myelomeningocele develop hydrocephalus and need CSF diversion, commonly a ventriculoperitoneal shunt (VPS) placement. The optimal timing of surgery is not known, but many centers delay VPS placement and perform it in a separate surgery to avoid shunt complications, mainly shunt contamination and infection. This systematic review and meta-analysis aimed to compare shunt-related complications between populations with VPS surgery performed either simultaneously with myelomeningocele closure or with delay.
METHODS: The authors searched MEDLINE (PubMed), Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews databases on December 15, 2022, and November 11, 2023, using a predefined search strategy. Randomized and nonrandomized trials of neonates undergoing postnatal myelomeningocele closure and VPS placement before the age of 29 days were included. Cases with prenatal myelomeningocele closure and hydrocephalus treatment other than a VPS were excluded. All studies were screened and assessed by two independent reviewers. The authors performed a meta-analysis pooling risk ratios (RRs) with a 95% CI using the random-effects model. The quality of studies was assessed using the Newcastle-Ottawa Scale.
RESULTS: After screening and a full-text review of 2099 database search results, 12 studies with a total number of 4894 patients were included. All studies were nonrandomized studies. Only 2 studies were ranked as good quality on the Newcastle-Ottawa Scale. No statistically significant differences were found between simultaneous and delayed shunt insertion in terms of shunt infection (RR 0.77, 95% CI 0.41-1.42); shunt revision (RR 0.49, 95% CI 0.19-1.30); overall mortality (RR 0.87, 95% CI 0.09-8.57); wound CSF leak (RR 0.20, 95% CI 0.03-1.23); or myelomeningocele wound dehiscence (RR 0.52, 95% CI 0.07-3.71). In the subgroup analysis of studies conducted in high-income countries, simultaneous shunting was superior to delayed shunting concerning shunt infection (RR 0.49, 95% CI 0.31-0.78) and shunt revision (RR 0.30, 95% CI 0.09-0.95).
CONCLUSIONS: This systematic review and meta-analysis found no statistically significant differences in shunt-related complications between simultaneous and delayed VPS surgery in myelomeningocele-related hydrocephalus in neonates. The current literature does not support the common practice of delayed shunting or its alternative, simultaneous shunting.
METHODS: The authors searched MEDLINE (PubMed), Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews databases on December 15, 2022, and November 11, 2023, using a predefined search strategy. Randomized and nonrandomized trials of neonates undergoing postnatal myelomeningocele closure and VPS placement before the age of 29 days were included. Cases with prenatal myelomeningocele closure and hydrocephalus treatment other than a VPS were excluded. All studies were screened and assessed by two independent reviewers. The authors performed a meta-analysis pooling risk ratios (RRs) with a 95% CI using the random-effects model. The quality of studies was assessed using the Newcastle-Ottawa Scale.
RESULTS: After screening and a full-text review of 2099 database search results, 12 studies with a total number of 4894 patients were included. All studies were nonrandomized studies. Only 2 studies were ranked as good quality on the Newcastle-Ottawa Scale. No statistically significant differences were found between simultaneous and delayed shunt insertion in terms of shunt infection (RR 0.77, 95% CI 0.41-1.42); shunt revision (RR 0.49, 95% CI 0.19-1.30); overall mortality (RR 0.87, 95% CI 0.09-8.57); wound CSF leak (RR 0.20, 95% CI 0.03-1.23); or myelomeningocele wound dehiscence (RR 0.52, 95% CI 0.07-3.71). In the subgroup analysis of studies conducted in high-income countries, simultaneous shunting was superior to delayed shunting concerning shunt infection (RR 0.49, 95% CI 0.31-0.78) and shunt revision (RR 0.30, 95% CI 0.09-0.95).
CONCLUSIONS: This systematic review and meta-analysis found no statistically significant differences in shunt-related complications between simultaneous and delayed VPS surgery in myelomeningocele-related hydrocephalus in neonates. The current literature does not support the common practice of delayed shunting or its alternative, simultaneous shunting.
摘要：
目的：约70%-80%出生时患有脊髓脊膜膨出的儿童发生脑积水，需要分流脑脊液，通常是脑室-腹腔分流术（VPS）放置。手术的最佳时机尚不清楚，但是许多中心延迟VPS的放置并在单独的手术中进行，以避免分流并发症，主要是分流污染和感染。这项系统评价和荟萃分析旨在比较VPS手术患者之间的分流相关并发症，该手术与脊髓膜膨出闭合同时进行或延迟进行。
方法：作者搜索了MEDLINE（PubMed），Scopus,WebofScience,Cochrane中央控制试验登记册,以及2022年12月15日和2023年11月11日的Cochrane系统评价数据库，使用预定义的搜索策略。纳入了29日龄前接受出生后脊髓膜膨出封闭和VPS放置的新生儿的随机和非随机试验。排除除VPS以外的产前脊髓膜膨出闭合和脑积水治疗的病例。所有研究均由两名独立评审员进行筛选和评估。作者使用随机效应模型进行了荟萃分析，汇集风险比（RR），CI为95％。使用纽卡斯尔-渥太华量表评估研究质量。
结果：经过筛选和2099数据库搜索结果的全文审查，包括12项研究，总人数为4894名患者。所有研究均为非随机研究。在纽卡斯尔-渥太华量表中，只有2项研究被评为高质量。在分流感染（RR0.77，95％CI0.41-1.42）；分流翻修（RR0.49，95％CI0.19-1.30）；总死亡率（RR0.87，95％CI0.09-8.57）；伤口脑脊液漏（RR0.20，95％CI-1.23）；或脊髓膜肿伤口裂隙（RR0.52，95％0.03）。在对高收入国家进行的研究的分组分析中，同时分流优于分流术感染(RR0.49,95%CI0.31-0.78)和分流术翻修(RR0.30,95%CI0.09-0.95)的延迟分流.
结论：这项系统评价和荟萃分析发现，在新生儿脊髓脊膜膨出相关性脑积水的同时行和延迟行VPS手术之间，分流相关并发症的差异无统计学意义。目前的文献不支持延迟分流或其替代的常见做法，同时分流。
方法：作者搜索了MEDLINE（PubMed），Scopus,WebofScience,Cochrane中央控制试验登记册,以及2022年12月15日和2023年11月11日的Cochrane系统评价数据库，使用预定义的搜索策略。纳入了29日龄前接受出生后脊髓膜膨出封闭和VPS放置的新生儿的随机和非随机试验。排除除VPS以外的产前脊髓膜膨出闭合和脑积水治疗的病例。所有研究均由两名独立评审员进行筛选和评估。作者使用随机效应模型进行了荟萃分析，汇集风险比（RR），CI为95％。使用纽卡斯尔-渥太华量表评估研究质量。
结果：经过筛选和2099数据库搜索结果的全文审查，包括12项研究，总人数为4894名患者。所有研究均为非随机研究。在纽卡斯尔-渥太华量表中，只有2项研究被评为高质量。在分流感染（RR0.77，95％CI0.41-1.42）；分流翻修（RR0.49，95％CI0.19-1.30）；总死亡率（RR0.87，95％CI0.09-8.57）；伤口脑脊液漏（RR0.20，95％CI-1.23）；或脊髓膜肿伤口裂隙（RR0.52，95％0.03）。在对高收入国家进行的研究的分组分析中，同时分流优于分流术感染(RR0.49,95%CI0.31-0.78)和分流术翻修(RR0.30,95%CI0.09-0.95)的延迟分流.
结论：这项系统评价和荟萃分析发现，在新生儿脊髓脊膜膨出相关性脑积水的同时行和延迟行VPS手术之间，分流相关并发症的差异无统计学意义。目前的文献不支持延迟分流或其替代的常见做法，同时分流。
