Endoscopic Evacuation of Massive Intraventricular Hemorrhages Reduces Shunt Dependency: A Meta-Analysis

Alessandro Fiorindi; Giorgio Saraceno; Luca Zanin; Lodovico Terzi di Bergamo; Alberto Feletti; Francesco Doglietto; Marco Maria Fontanella

doi:10.1055/s-0042-1757220

Asian Journal of Neurosurgery, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Asian J Neurosurg 2022; 17(04): 541-546
DOI: 10.1055/s-0042-1757220

Review Article

Endoscopic Evacuation of Massive Intraventricular Hemorrhages Reduces Shunt Dependency: A Meta-Analysis

Alessandro Fiorindi

¹Department of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy

,

Giorgio Saraceno

¹Department of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy

,

Luca Zanin

¹Department of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy

,

Lodovico Terzi di Bergamo

²Institute of Oncology Research, Bellinzona, Switzerland

,

Alberto Feletti

³Department of Neurosciences, Biomedicine and Movement Sciences, Institute of Neurosurgery, University of Verona, AOUI Verona, Polo Chirurgico “P. Confortini,” Italy

,

Francesco Doglietto

⁴Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy

,

Marco Maria Fontanella

¹Department of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy

› Institutsangaben

Abstract

Intraventricular hemorrhage (IVH) is characterized by severe prognosis. The amount of intraventricular blood is the most important, disease-specific, prognostic factor, as acute complications are strictly dependent on clot formation. Although external ventricular drain (EVD) placement is the standard treatment, in the past 15 years neuroendoscopic (NE) evacuation of IVH has been advocated, but available comparative data are limited. A systematic review of the literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles compare the treatment of primary and secondary IVH with NE and EVD. The meta-analysis was performed in terms of shunt dependency. Cochran's Q-test and I2 statistics were used to assess heterogeneity in the studies. No heterogeneity was considered for p greater than 0.05 and I2 less than 20%. A random-effect model was used, with restricted maximum likelihood to estimate the heterogeneity variance. After screening 744 articles, 5 were included in the meta-analysis. A total of 303 patients presenting with primary or pure (50 patients) and secondary (253 patients) IVH, undergoing either NE (151) or EVD (152), were included in the metanalysis. The risk of ventriculoperitoneal (VP) shunt was higher in the EVD group (relative risk: 1.93, 95% confidence interval: 1.28–2.92, p = 0.0094). The risk of VP shunt was higher in the EVD group, but the overall outcome remains poor for patients with IVH, with a moderate-to-high disability. Large randomized controlled trials are needed to evaluate more deeper both advantages and effects on the outcome of NE over EVD.

Keywords

intraventricular hemorrhage - neuroendoscopy - ventriculoperitoneal shunt - external ventricular drainage - hydrocephalus

Volltext

Referenzen

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