Reduction cranioplasty for hydrocephalic macrocephaly: a systematic review of surgical outcomes.

IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY
Journal of neurosurgery. Pediatrics Pub Date : 2024-06-21 Print Date: 2024-09-01 DOI:10.3171/2024.4.PEDS23486
Steven P Moura, Alexandra D Center, Manasa Kalluri, Jessica Blum, Ellen C Shaffrey, Samuel Lee, Jinggang J Ng, Bermans J Iskandar, Catharine B Garland, Daniel Y Cho
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Abstract

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.

治疗巨脑畸形的缩颅成形术:手术效果的系统回顾。
目的:巨颅症可导致心理发育不良、定位困难、皮肤破损和外观不佳。尽管缩颅成形术可以解决这些后遗症,但由于巨脑畸形的罕见性,缩颅成形术的术后效果、并发症和死亡风险尚不十分清楚。因此,本系统性综述的主要目的是评估缩颅成形术治疗巨脑畸形的手术效果:方法:我们使用 PubMed、Scopus 和 Web of Science 数据库进行了系统性综述,同时遵循了《系统性综述和元分析首选报告项目》指南。两位独立审稿人筛选了 350 项研究,其中有 27 项研究报告了缩颅成形术治疗巨脑畸形的手术效果,符合纳入标准。收集了有关研究设计、患者人口统计学、手术细节和手术结果的数据:结果:在纳入的 27 项研究中,共有 65 例缩颅成形术。18项(66.7%)研究提供了V级证据,7项(25.9%)提供了IV级证据,2项(7.4%)提供了III级证据。缩颅成形术后,23 项(85.2%)研究的术后头部定位有所改善,22 项(81.5%)研究的术后外观有所改善,20 项(74.1%)研究的术后整体神经功能有所改善。估计失血量的中位数为 633 毫升(范围为 20-2600 毫升)。分流管修补是最常见的并发症,19 项评估并发症的研究中有 9 项(47.4%)报告了这一情况。在 65 例患者中,死亡率为 6.2%(4 例):结论:所纳入的大多数研究报告称,针对巨脑畸形进行缩颅成形术后,患者的头部大小、头部定位、头颅外观和整体神经功能均有所改善。然而,低水平证据、失血风险、并发症和死亡率的普遍性表明,在进行这些复杂手术时,需要认真讨论手术指征、经验丰富的团队和周密的围手术期计划。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of neurosurgery. Pediatrics
Journal of neurosurgery. Pediatrics 医学-临床神经学
CiteScore
3.40
自引率
10.50%
发文量
307
审稿时长
2 months
期刊介绍: Information not localiced
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