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World Neurosurg. 2018 Nov;119:e216-e227. doi: 10.1016/j.wneu.2018.07.119. Epub 2018 Jul 23.

The Incidence of Hydrocephalus and Shunting in Patients with Angiogram-Negative Subarachnoid Hemorrhage: An Updated Meta-Analysis.

Author information

1
Department of Emergency Medicine, Seoul Emergency Operations Center, Seoul, Korea.
2
Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Korea.
3
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
4
Department of Radiology, Hallym University College of Medicine, Chuncheon, Korea.
5
Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Korea; Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea. Electronic address: jjs6553@daum.net.

Abstract

OBJECTIVE:

To evaluate the incidence of hydrocephalus and implanted shunts in angiogram-negative subarachnoid hemorrhage (SAH) according to hemorrhage patterns: perimesencephalic SAH (PMH) versus non-PMH.

METHODS:

The online database literature from January 1990 to November 2017 was systematically reviewed. A fixed-effect model was used when heterogeneity was <50%. A Begg funnel plot was used to assess publication bias. An additional trim and fill method was used to estimate the number of missing studies. A subgroup analysis with studies, which defined angiogram-negative SAH using repeated angiography or computed tomography angiography, was further performed.

RESULTS:

A total of 28 articles including 2577 patients were enrolled. Patients with PMH showed a significantly decreased incidence of hydrocephalus (odds ratio [OR], 0.269; 95% confidence interval [CI], 0.208-0.348) and shunts (OR, 0.263; 95% CI, 0.169-0.411) than did patients without PMH. A subgroup analysis of 7 studies with 675 patients showed less hydrocephalus in patients with PMH than in patients without PMH (OR, 0.358; 95% CI, 0.161-0.793), with possible publication bias. Shunt procedures were marginally less common in patients with PMH compared with those patients without PMH (OR, 0.490; 95% CI, 0.236-1.018) with possible publication bias. After correction of the forest plot, the adjusted OR was 0.617 (95% CI, 0.251-1.513) for hydrocephalus and 0.618 (95% CI, 0.310-1.232) for shunts, suggesting no significant relationships between PMH and the risk of hydrocephalus or shunting.

CONCLUSIONS:

Hydrocephalus and shunts were more evident in non-PMH than PMH. However, subgroup analyses did not show significant associations between PMH and lower risks of these events after correction for possible publication bias. Further meta-analyses based on individual patient data are necessary.

KEYWORDS:

Hydrocephalus; Shunt; Subarachnoid hemorrhage

PMID:
30048789
DOI:
10.1016/j.wneu.2018.07.119
[Indexed for MEDLINE]

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