脑积水是神经外科实践中常见的病理。自从Mikulicz在1893年描述了第一个永久性的心室-蛛网膜下-延髓分流术以来,人们多次尝试寻找解决方案,以从大脑中排出过量的脑脊液(CSF)/减少的再吸收。如今,最常见的技术是脑室-腹腔分流术(VPS),而室心房分流术(VAS)仅在某些罕见情况下应用。迄今为止,文献中仍然没有具体的指南或有力的证据来指导外科医生在两种方法之间的选择。决定通常取决于外科医生的信心和专业知识。考虑到缺乏既定建议,本系统综述和荟萃分析旨在评估这两种分流技术的有效性和安全性.本系统评价是根据PRISMA方案(系统评价和荟萃分析的首选报告项目)进行的。不包括研究出版物的时间顺序限制。前瞻性和回顾性临床研究,和每组至少5例患者的病例系列报告以及VAS和VPS技术比较的报告数据符合纳入条件.9项研究报告3197名符合纳入和排除标准的患者被确定并纳入定量综合。VAS组分流功能障碍/阻塞的风险显著降低[比值比(OR)0.49,95%-CI0.34-0.70,I20%]。两组之间的感染风险没有显着差异(OR1.02,95%-CI0.59-1.74,I20%)。两组之间的修订风险没有显着差异;但是,研究之间的异质性显著(OR0.73,95%-CI0.36-1.49,I291%).此外,两组之间的死亡风险没有显着差异;但是,研究之间的异质性较高(OR1.93,95%-CI0.81-4.62,I264%).VAS仍然是脑积水的安全手术替代方法。这项研究的结果强调了VAS组中分流功能障碍/阻塞变量的风险较低,关于至少一种感染相关并发症的发生率没有显着统计学差异。因此,这两种技术之间的选择必须根据患者的具体特征进行调整。方案注册:审查方案已在前瞻性系统审查注册(PROSPERO)(www。crd.约克。AC.英国/PROSPERO)网站,注册号:CRD42023479365。
Hydrocephalus is a commonly encountered pathology in the neurosurgical practice. Since the first permanent ventriculo-subarachnoid-subgaleal
shunt described by Mikulicz in 1893, there were multiple attempts to find solutions for draining the excess production/less reabsorption of the cerebrospinal fluid (CSF) from the brain. Nowadays, the most common technique is the ventriculoperitoneal
shunt (VPS), whereas the ventriculoatrial
shunt (VAS) is applied only in some rare conditions. To date there are still no specific guidelines or strong evidence in literature that guide the surgeon in the choice between the two methods, and the decision usually relies on the confidence and expertise of the surgeon. Considering the lack of established recommendations, this systematic review and meta-analysis aims to evaluate the effectiveness and safety of these two shunting techniques. This systematic review was conducted following the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). No chronological limits of study publications were included. Prospective and retrospective clinical studies, and reports of case series with at least five patients per group and reporting data on comparison between VAS and VPS techniques were eligible for inclusion. Nine studies reporting 3197 patients meeting the inclusion and exclusion criteria were identified and included in the quantitative synthesis. The risk of
shunt dysfunction/obstruction was significantly lower in the VAS group [odds ratio (OR) 0.49, 95%-CI 0.34-0.70, I2 0%]. The risk of infection was not significantly different between the two groups (OR 1.02, 95%-CI 0.59-1.74, I2 0%). The risk of revision was not significantly different between the two groups; however, the heterogeneity between the studies was significant (OR 0.73, 95%-CI 0.36-1.49, I2 91%). Additionally, the risk of death was not significantly different between the two groups; however, the heterogeneity between the studies was high (OR 1.93, 95%-CI 0.81-4.62, I2 64%). VAS remains a safe surgical alternative for hydrocephalus. The results of this study highlight a lower risk of
shunt dysfunction/obstruction variable in the VAS group, with no significant statistical differences regarding the occurrence of at least one infection-related complication. In consequence, the choice between these two techniques must be tailored to the specific characteristics of the patient.Protocol Registration: The review protocol was registered and published in Prospective Register of Systematic Reviews (PROSPERO) ( www.crd.york.ac.uk/PROSPERO ) website with registration number: CRD42023479365.