Medical Student University of West of Santa Catarina, Santa Catarina, Joaçaba, Brazil
Introduction: Hydrocephalus, marked by cerebrospinal fluid buildup in the brain, is often managed with shunt placement to alleviate symptoms. However, long-term outcomes are affected by complications like infections and obstructions. This systematic review and meta-analysis assess the long-term efficacy and safety of shunts in hydrocephalus patients, focusing on survival, quality of life, and complications.
Methods: Following PRISMA guidelines, we conducted comprehensive searches in PubMed, Embase, and Web of Science. Two independent reviewers screened studies, with a third reviewer resolving any discrepancies. Eligible studies included hydrocephalus patients treated with shunts with at least 3 years of follow-up, examining infection or shunt-related mortality. Statistical analyses were performed in R Studio, with heterogeneity considered high at an I² > 35%, with sub analysis being conducted to mitigate the high value.
Results: A total of 7,682 studies were initially identified, with 22 meeting inclusion criteria, representing 5,526 patients. Infection risk analysis, based on data from 4,733 patients, revealed a 17% risk (95% CI: 0.12–0.22; I²=91%), consistent with findings from studies conducted in the last 20 years, which showed a similar 17% risk (95% CI: 0.12–0.24; I²=92%) across 3,912 patients. Analysis of procedure-related mortality among 3,537 patients revealed an 11% risk (95% CI: 0.00–0.25; I²=99%); recent studies, encompassing 2,615 patients, showed a reduced risk of 6% (95% CI: 0.00–0.11; I²=92%). Sensitivity analysis identified no significant outliers.
Conclusion : Despite this study's findings, high heterogeneity in hydrocephalus literature complicates definitive conclusions. However, persistent high infection and mortality rates, as well as high I2 values, even in recent studies, highlights the need for improved treatments and a standardized reporting guideline to advance hydrocephalus research.
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