Incidence of post-traumatic hydrocephalus in traumatic brain injury patients that underwent DC versus those that were managed without DC: A systematic review and meta-analysis

Georgios Mavrovounis; Adamantios Kalogeras; Alexandros Brotis; Corrado Iaccarino; Andreas K Demetriades; Konstantinos N Fountas

doi:10.1016/j.bas.2021.100303

Incidence of post-traumatic hydrocephalus in traumatic brain injury patients that underwent DC versus those that were managed without DC: A systematic review and meta-analysis

Brain Spine. 2021 Oct 22:1:100303. doi: 10.1016/j.bas.2021.100303. eCollection 2021.

Authors

Georgios Mavrovounis¹, Adamantios Kalogeras¹, Alexandros Brotis¹, Corrado Iaccarino², Andreas K Demetriades³, Konstantinos N Fountas¹

Affiliations

¹ Department of Neurosurgery, Faculty of Medicine, University of Thessaly, Larisa, Greece.
² Division of Neurosurgery, Department of Biomedical, Metabolic and Neural Sciences, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy.
³ Department of Neurosurgery, New Royal Infirmary, Edinburgh, UK.

Abstract

Introduction: There is an ongoing debate whether Decompressive Craniectomy (DC) serves as an independent risk factor for the development of Post-traumatic Hydrocephalus (PTH).

Research question: The aim of this systematic review and meta-analysis was to compare the incidence of PTH in TBI patients that underwent DC versus those that were managed without DC.

Materials and methods: The literature was systematically reviewed to identify studies with specific inclusion criteria: (1) Randomized Controlled Trials and observational studies with more than 10 patients in each study arm, (2) comparing the incidence of PTH, (3) in patients aged ≥15 years old, (4) that either underwent DC or received other treatment (non-DC). (5) Only studies in English were included and (6) no restrictions were applied on publication date. The pooled Odds Ratio (OR) and Confidence Interval (CI) were calculated. The quality of the included studies was assessed using the ROBINS and RoB 2.0 tools.

Results: Evidence from six articles was synthesized, incorporating data from 2522 patients. A statistically significant higher occurrence of PTH [OR (95% CI): 4.84 (2.51, 9.31); Pz < 0.00001] was identified in patients undergoing DC for TBI when compared to those that were managed without DC. The same was true when only patients with severe TBI were included in the analysis [OR (95% CI): 2.87 (1.85, 4.43); Pz < 0.00001].

Discussion and conclusion: Our study has shown, within limitations, a clear association between DC and PTH. Further prospective studies, providing high-quality evidence, are needed to definitively establish any causative relationship between DC and PTH.

Keywords: CI, Confidence Interval; CSF, Cerebrospinal fluid; DC, Decompressive Craniectomy; Decompressive craniectomy; GCS, Glasgow Coma Scale; ICP, Intracranial pressure; Intracranial pressure; OR, Odds Ratio; PTH, Post-traumatic hydrocephalus; Post-traumatic hydrocephalus; RCT, Randomized Controlled Trial; RoB 2.0, Risk of Bias 2.0; TBI, Traumatic Brain Injury; Traumatic brain injury.