Cranioplasty Combined With Shunt In The Treatment Of Skull Defect And Hydrocephalus After Craniocerebral Surgery:a Meta-analysis

Objective:To evaluate the differences of postoperative complications after simultaneous cranioplasty,ventriculoperitoneal shunt and stage-delayed ventriculoperitoneal shunt by meta-analysis.Methods:The literatures about the randomized controlled trial(RCT)and case-control studies of Cranioplasty and ventriculoperitoneal shunt were performed simultaneously and ventriculoperitoneal shunt was delayed for cranioplasty were collected from Pubmed,Embanse,Cochrane Libraryand other major English databases;CNKI,Wanfang Database,Wipp database other major Chinese databases from January 2008 to March 2020;RevMan5.3 software was used for Meta analysis of the complication data.Results:Seventeen case-control studies were selected finally.There were 995 patients in total including 489 receiving concurrent surgery and 506 undergoing staged surgery.The comprehensive results of Meta analysis showed as follows:Simultaneous surgery has fewer shunt failure rates and excessive shunt rates,In the case of brain trauma as a causative factor,the incidence of infection is lower,But it has a higher overall complication rate,in the same period of surgery(both P<0.05)There was no statistically significant difference in the cerebrospinal fluid leakage,insufficient shunt,intracranial hemorrhage,postoperative fever,and postoperative subdural effusion(all P > 0.05).Conclusion:Simultaneous and staging surgical treatment had little difference in cerebrospinal fluid leakage,insufficient shunt,intracranial hemorrhage,postoperative fever,and postoperative subdural effusion.In the case of craniocerebral injury after decompressive decompression of hydrocephalus,the concurrent infection has a lower infection rate,But it has a higher overall complication rate;while in other mixed etiology groups,They are not much different.Shunt tube failure and excessive shunting are lower in the contemporaneous group.