目标:患病率,管理,在非洲,脑积水的结局仍未得到充分开发。本研究旨在分析人口统计学和临床特征,评估治疗策略,并评估非洲儿童脑积水的神经系统结局。
方法:使用PubMed对文献进行系统回顾,谷歌学者,和WebofScience电子数据库是根据PRISMA指南完成的,以确定描述非洲儿童脑积水患者的文章。
结果:纳入了74项回顾性和前瞻性研究以及33例病例报告,涉及12,355例患者。在54篇报告患者人口统计学的回顾性文章中,53.8%(3926/7297)为男性,平均年龄为12.3个月。19项研究报告了大头畸形(80.2%,1639/2043)作为最常见的演示文稿。据报道,脑积水的病因为感染后(41.0%,2303/5614)跨越27条和先天性(48.6%,1246/2563)在10篇文章中。11篇文献报道46.7%(609/1305)的患者患有交通性脑积水,而53.3%(696/1305)的患者患有阻塞性脑积水。诊断影像学包括CT(76.1%,2435/3202;n=29条),超声检查(72.9%,2043/2801;n=15篇文章),和MRI(44.8%,549/1225;n=11篇文章)。在51篇文章中,83.1%(7365/8865)的患者进行了脑室腹膜分流(VPS),而33篇文献描述了54.1%(2795/5169)接受内窥镜第三脑室造口术(ETV)进行脑积水手术治疗。术后并发症包括脓毒症(6.9%,29/421;n=4篇文章),手术部位感染(5.1%,11/218;n=4篇文章),和脑脊液泄漏(2.0%,15/748;n=8篇文章)。分流相关并发症包括感染(4.3%,117/2717;n=21篇文章)和阻塞(4.1%,34/829;n=6项研究)。在15篇文章中,9.0%(301/3358)的分流患者进行了修订。平均随访时间为18.9±16.7个月,总死亡率为7.4%(397/5383;n=29篇)。在比较研究的分析中,与接受VPS的158例患者相比,接受ETV的160例患者显示出手术成功的几率(OR1.54,95%CI0.51-4.69;p=0.03)和最后一次随访时神经系统改善(OR3.36,95%CI0.46-24.79;p<0.01),但两组在并发症和死亡率方面差异无统计学意义(p>0.05)。
结论:这篇综述提供了非洲儿童脑积水的全面总结,强调分流是主要治疗方法。然而,观察到的研究差异突出了建立报告患者特征的标准化指南的必要性,管理策略,和结果,以确保文章的一致性和可比性。
OBJECTIVE: The prevalence, management, and outcomes of hydrocephalus remain underexplored in Africa. This study aimed to analyze demographic and clinical features, evaluate treatment strategies, and assess neurological outcomes of pediatric hydrocephalus in Africa.
METHODS: A systematic review of the literature using the PubMed, Google Scholar, and Web of Science electronic databases was completed according to the PRISMA guidelines to identify articles describing pediatric patients in Africa with hydrocephalus.
RESULTS: Seventy-four retrospective and prospective studies and 33 case reports involving 12,355 patients were included. In 54 retrospective articles reporting patient demographics, 53.8% (3926/7297) were male with a mean age of 12.3 months. Nineteen studies reported macrocephaly (80.2%, 1639/2043) as the most common presentation. The etiology of hydrocephalus was reported as postinfectious (41.0%, 2303/5614) across 27 articles and congenital (48.6%, 1246/2563) in 10 articles. Eleven articles reported 46.7% (609/1305) of patients had communicating hydrocephalus while 53.3% (696/1305) had obstructive hydrocephalus. Diagnostic imaging included CT (76.1%, 2435/3202; n = 29 articles), ultrasonography (72.9%, 2043/2801; n = 15 articles), and MRI (44.8%, 549/1225; n = 11 articles). In 51 articles, 83.1% (7365/8865) of patients had ventriculoperitoneal shunting (VPS) while 33 articles described 54.1% (2795/5169) receiving endoscopic third ventriculostomy (ETV) for hydrocephalus surgical management. Postoperative complications included sepsis (6.9%, 29/421; n = 4 articles), surgical site infections (5.1%, 11/218; n = 4 articles), and CSF leaks (2.0%, 15/748; n = 8 articles). Shunt-related complications included infections (4.3%, 117/2717; n = 21 articles) and blockages (4.1%, 34/829; n = 6 studies). In 15 articles, 9.0% (301/3358) of patients with shunts had revisions. The mean follow-up duration was 18.9 ± 16.7 months with an overall mortality rate of 7.4% (397/5383; n = 29 articles). In the analysis of comparative studies, the 160 patients undergoing ETV demonstrated significantly higher odds of a successful operation (OR 1.54, 95% CI 0.51-4.69; p = 0.03) and neurological improvement at last follow-up (OR 3.36, 95% CI 0.46-24.79; p < 0.01) compared with the 158 who received VPS, but no significant differences were observed for complications and mortality between the two groups (p > 0.05).
CONCLUSIONS: This review offers a comprehensive summary of pediatric hydrocephalus in Africa, highlighting shunting as the primary treatment. However, the observed variations across studies highlight the need to establish standardized guidelines for reporting patient characteristics, management strategies, and outcomes to ensure consistency and comparability in articles.