Cranioplasty infection and resorption are associated with presence of a ventriculoperitoneal shunt: A systematic review and meta-analysis.

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Cranioplasty infection and resorption are associated with presence of a ventriculoperitoneal shunt: A systematic review and meta-analysis.

World Neurosurg. 2017 Apr 18;:

Authors: Mustroph CM, Malcolm JG, Rindler RS, Chu JK, Grossberg JA, Pradilla G, Ahmad FU

Abstract
BACKGROUND: Following decompressive craniectomy, hydrocephalus is a common complication often requiring placement of a ventriculoperitoneal shunt (VPS). Complications in the presence of a VPS have been reported but without clear association.
METHODS: PRISMA guidelines were used to perform a literature search using PubMed to identify articles that published the complication rates associated with staged or simultaneous cranioplasty and VPS. From event rates, odds ratios [OR, 95% Confidence Interval (CI)] of complications were calculated. Data was pooled using the Mantel-Haenszel method. The Oxford Center for Evidence-Based Medicine guidelines was used to assess the quality of individual articles and studies. The Newcastle-Ottawa Scale was used to assess the risk of bias in studies.
RESULT: Of the 30 papers reviewed for complications in the presence and absence of a VPS, seven studies with 1635 patients were eligible for meta-analysis. Overall complications (n=1635, OR 9.75, CI 4.8-20.1), infection (OR 4.9, CI 2.2-10.7), and bone resorption (OR 10.6, CI 4.9-23.0) were increased when a VPS is present at the time of cranioplasty. Simultaneous procedures were associated with increased complication rate (n=283, OR 4.3, CI 2.3-8.2) compared to staged procedures.
CONCLUSIONS: Cranioplasty in the presence of a VPS is associated with a higher rate of overall complications, including infection and bone resorption. Performing VPS and cranioplasty in the same operation is associated with an increased complication rate compared to staged procedures. Surgeons should consider staging these procedures when possible and counsel patients about these risks.

PMID: 28434961 [PubMed - as supplied by publisher]

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