Are ventriculopleural shunts the second option for treating hydrocephalus? A meta-analysis of 543 patients.

Autor: Oliveira LB; Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa, PR, Brazil. Electronic address: leobarrosoliveira09@gmail.com., Porto S Jr; Department of Neurosurgery, Bahiana Medical School, Salvador, BA, Brazil. Electronic address: silviojr1212@gmail.com., Andreão FF; Department of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil. Electronic address: filipiandreao1@gmail.com., Ferreira MY; Department of Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA. Electronic address: marcioferreiramed@gmail.com., Bocanegra-Becerra JE; Department of Neurosurgery, Universidad Peruana Cayetano Heredia, Lima, Peru. Electronic address: jhon.bocanegra.b@upch.pe., Verly G; Department of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil. Electronic address: verly.gabriel@gmail.com., Palavani LB; Department of Neurosurgery, Max Planck University Center, Indaiatuba, SP, Brazil. Electronic address: lucca.palavani730@al.Unieduk.com.br., Batista S; Department of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil. Electronic address: saviobatista360@gmail.com., Gutierrez-Aguirre SF; Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, FL, USA; Jacksonville University, Jacksonville, FL, USA. Electronic address: sfga180897@gmail.com., Toledo OF; Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, FL, USA; Jacksonville University, Jacksonville, FL, USA. Electronic address: otavioftoledo@gmail.com., Rabelo NN; Department of Neurosurgery, University of São Paulo, São Paulo, SP, Brazil. Electronic address: nicollasrabelo@hotmail.com., Welling LC; Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa, PR, Brazil. Electronic address: leonardowelling@yahoo.com.br., Bertani R; Department of Neurosurgery, University of São Paulo, São Paulo, SP, Brazil. Electronic address: neurosurgery@rbertani.com., Figueiredo EG; Department of Neurosurgery, University of São Paulo, São Paulo, SP, Brazil. Electronic address: ebgadelha@yahoo.com.
Jazyk: angličtina
Zdroj: Clinical neurology and neurosurgery [Clin Neurol Neurosurg] 2024 Sep; Vol. 244, pp. 108396. Date of Electronic Publication: 2024 Jun 28.
DOI: 10.1016/j.clineuro.2024.108396
Abstrakt: Background: Some centers utilize ventriculopleural shunt (VPLS) for treating hydrocephalus when conventional approaches are not feasible. Nonetheless, the literature regarding this approach is scarce.
Purpose: Evaluate the outcomes of VPLS through a single-arm meta-analysis.
Methods: Following PRISMA guidelines, the authors systematically searched for articles utilizing the VPLS in a cohort with more than four patients. Outcomes included: mortality, pleural effusion, number of patients who underwent revisions, obstructions, shunt migration, emphysema, and subdural hematoma.
Results: A total of 404 articles were reviewed, resulting in the inclusion of 13 retrospective studies encompassing 543 patients, with the majority being children (62.6 %). The median average follow-up period was 35.4 months (10-64.1). After analysis, results yielded a revision rate of 54 % (95 % CI: 44 %-64 %; I 2 =73 %). The most common complication observed was pleural effusion, with a post-analysis incidence of 16 % (95 % CI: 11 %-21 %; I 2 =63 %), followed by infections at 7 % (95 % CI: 4 %-10 %; I 2 =33 %). Shunt obstruction occurred in 13 % (95 % CI: 4 %-21 %; I 2 =84 %) of cases after analysis, while migrations, overdrainage, subdural hematoma, and cutaneous emphysema had minimal occurrence rates (0 %, 95 % CI: 0 %-1 %; I 2 =0 %). Notably, there were no reported cases of shunt-related mortality.
Conclusion: VPLS can be considered when there are no other suitable options for placing the distal catheter. However, the notable rates of shunt revisions, pleural effusion, infections, and the inherent heterogeneity of outcomes currently limit the widespread adoption of VPLS. In this scenario, other alternatives should be given priority.
Competing Interests: Declaration of Competing Interest None.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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