目的:脑积水可导致心理社会发育不良,定位困难,皮肤破裂,和可怜的宇宙。虽然复位颅骨修补术可以解决这些后遗症,术后结果,并发症,考虑到脑积水的稀有性,颅骨成形术的死亡率风险尚不清楚。因此,本系统综述的主要目的是评估复位颅骨成形术治疗脑积水的手术效果。
方法:使用PubMed进行了系统评价,Scopus,和WebofScience数据库,同时遵循系统评论和荟萃分析指南的首选报告项目。两名独立评审者筛选了350项研究;27项研究报告了脑积水的颅骨成形术手术结果符合纳入标准。研究设计数据,患者人口统计学,操作细节,收集手术结果。
结果:在27项纳入的研究中,有65例颅骨成形术复位。18项(66.7%)研究提供了V级证据,7(25.9%)提供了IV级证据,2份(7.4%)提供三级证据。复位颅骨成形术后,在23项(85.2%)研究中,术后头部定位有所改善,在22项(81.5%)研究中,术后美容效果有所改善,在20项(74.1%)研究中,整体术后神经功能得到改善。中位估计失血量为633mL(范围20-2600mL)。分流术是最常见的并发症,在19项评估并发症的研究中,有9项(47.4%)报道。在65名患者中,死亡率为6.2%(n=4).
结论:大多数纳入的研究报告了头部大小的改善,头部定位,颅骨宇宙,复位颅骨成形术治疗脑积水后的整体神经功能。然而,低级证据的流行,失血的风险,并发症,死亡率表明需要认真讨论手术适应症,一个经验丰富的团队,和彻底的围手术期计划来执行这些复杂的手术。
OBJECTIVE: Hydrocephalic macrocephaly can result in poor psychosocial development, positioning difficulties, skin breakdown, and poor cosmesis. Although reduction cranioplasty can address these sequelae, the postoperative outcomes, complications, and mortality risk of reduction cranioplasty are not well understood given the rarity of hydrocephalic macrocephaly. Therefore, the primary objective of this systematic review was to evaluate the surgical outcomes of reduction cranioplasty for the treatment of hydrocephalic macrocephaly.
METHODS: A systematic review was performed using the PubMed, Scopus, and Web of Science databases while following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent reviewers screened 350 studies; 27 studies reporting surgical outcomes on reduction cranioplasty for hydrocephalic macrocephaly met inclusion criteria. Data on study design, patient demographics, operative details, and surgical outcomes were collected.
RESULTS: There were 65 reduction cranioplasties among the 27 included studies. Eighteen (66.7%) studies presented level V evidence, 7 (25.9%) presented level IV evidence, and 2 (7.4%) presented level III evidence. Following reduction cranioplasty, there was improvement in postoperative head positioning in 23 (85.2%) studies, improvement in postoperative cosmesis in 22 (81.5%) studies, and improvement in global postoperative neurological functioning in 20 (74.1%) studies. The median estimated blood loss was 633 mL (range 20-2600 mL). Shunt revisions were the most common complication, reported in 9 (47.4%) of the 19 studies assessing complications. Of the 65 patients, there was a mortality rate of 6.2% (n = 4).
CONCLUSIONS: The majority of the included studies reported improvement in head size, head positioning, cranial cosmesis, and global neurological functioning following reduction cranioplasty for hydrocephalic macrocephaly. However, the prevalence of lower-level evidence, risk of blood loss, complications, and mortality indicates the need for a serious discussion of surgical indication, an experienced team, and thorough perioperative planning to perform these complex surgeries.