Cerebrospinal fluid predictors of shunt-dependent hydrocephalus after hemorrhagic stroke: a systematic review and meta-analysis

Abstract Background Cerebrospinal fluid (CSF) leakage is a common complication after neurosurgical intervention. It is associated with substantial morbidity and increased healthcare costs. The current systematic review and meta-analysis aim to quantify the incidence of cerebrospinal fluid leakage in the pediatric population and identify its risk factors. Methods The authors followed the PRISMA guidelines. The Embase, PubMed, and Cochrane database were searched for studies reporting CSF leakage after intradural cranial surgery in patients up to 18 years old. Meta-analysis of incidences was performed using a generalized linear mixed model. Results Twenty-six articles were included in this systematic review. Data were retrieved of 2929 patients who underwent a total of 3034 intradural cranial surgeries. Surprisingly, only four of the included articles reported their definition of CSF leakage. The overall CSF leakage rate was 4.4% (95% CI 2.6 to 7.3%). The odds of CSF leakage were significantly greater for craniectomy as opposed to craniotomy (OR 4.7, 95% CI 1.7 to 13.4) and infratentorial as opposed to supratentorial surgery (OR 5.9, 95% CI 1.7 to 20.6). The odds of CSF leakage were significantly lower for duraplasty use versus no duraplasty (OR 0.41 95% CI 0.2 to 0.9). Conclusion The overall CSF leakage rate after intradural cranial surgery in the pediatric population is 4.4%. Risk factors are craniectomy and infratentorial surgery. Duraplasty use is negatively associated with CSF leak. We suggest defining a CSF leak as “leakage of CSF through the skin,” as an unambiguous definition is fundamental for future research.

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The Prognostic Significance of Biomarkers in Cerebrospinal Fluid Following Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis

SSRN Electronic Journal ◽

10.2139/ssrn.3941039 ◽

2021 ◽

Author(s):

Victor Schwartz Hvingelby ◽

Carsten Bjarkam ◽

Frantz Rom Poulsen ◽

Tiit Illimar Mathiesen ◽

Morten Thingemann Bøtker ◽

...

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Cerebrospinal Fluid ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Meta Analysis ◽

Prognostic Significance

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Cilostazol Mono and Combination Treatments in Ischemic Stroke

Stroke ◽

10.1161/strokeaha.119.026655 ◽

2019 ◽

Vol 50 (12) ◽

pp. 3503-3511 ◽

Cited By ~ 5

Author(s):

Seung Min Kim ◽

Jin-Man Jung ◽

Bum Joon Kim ◽

Ji-Sung Lee ◽

Sun U. Kwon

Keyword(s):

Myocardial Infarction ◽

Systematic Review ◽

Ischemic Stroke ◽

Hemorrhagic Stroke ◽

Recurrent Stroke ◽

Meta Analysis ◽

Significant Heterogeneity ◽

Randomized Controlled ◽

Combination Treatments ◽

Composite Outcomes

Background and Purpose— We performed a systematic review and meta-analysis to explore the efficacy and safety of cilostazol as a mono or combination (plus aspirin or clopidogrel) treatments compared to conventional single antiplatelet therapy (SAPT, mainly aspirin) for secondary stroke prevention. Methods— Randomized controlled trial studies were searched across multiple comprehensive databases (MEDLINE, EMBASE, and Cochrane) for review. The primary outcome was recurrent stroke comprising ischemic and hemorrhagic stroke. Secondary outcomes included ischemic stroke, hemorrhagic stroke, myocardial infarction, and composite outcomes. We performed an updated systematic review and meta-analysis of the identified reports, including 2 recently published randomized controlled trials. In addition, network meta-analysis was performed to compare the relative effects of mono versus combination cilostazol treatments. Results— Ten studies were included in this review, 5 of which were assigned to the cilostazol mono group (n=5429) and the other 5 to the combination group (n=2456). The relative risks of recurrent stroke, ischemic stroke, and composite outcomes with cilostazol mono as well as combination treatments were significantly lower than with SAPT without any significant heterogeneity. An indirect comparison of these 3 outcomes revealed the cilostazol combination approach to be superior. The cilostazol mono treatment diminished hemorrhagic stroke more significantly than SAPT and the cilostazol combination did not increase hemorrhagic stroke compared to SAPT. The outcomes from the 2 cilostazol regimens were comparable to SAPT in the case of myocardial infarction. Conclusions— Cilostazol is a more effective and safer treatment option than SAPT approaches using mainly aspirin. Cilostazol regimens can also be modified to clinical situations as this drug reduces recurrent and ischemic stroke more efficiently as a combination therapy but is more beneficial for hemorrhagic stroke as a monotherapy.

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Cerebrospinal fluid and blood levels of neurofilament light chain in traumatic brain injury: a systematic review and meta-analysis

10.37766/inplasy2020.10.0031 ◽

2020 ◽

Author(s):

Eleni Karantali ◽

Dimitrios Kazis ◽

Symela Chatzikonstantinou ◽

Jack McKena ◽

Fivos Petridis ◽

...

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Cerebrospinal Fluid ◽

Brain Injury ◽

Light Chain ◽

Meta Analysis ◽

Blood Levels ◽

Neurofilament Light Chain ◽

Neurofilament Light

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Low-Density Lipoprotein Cholesterol and Risk of Hemorrhagic Stroke: a Systematic Review and Dose-Response Meta-analysis of Prospective Studies

Current Atherosclerosis Reports ◽

10.1007/s11883-019-0815-5 ◽

2019 ◽

Vol 21 (12) ◽

Cited By ~ 4

Author(s):

Chaoran Ma ◽

Muzi Na ◽

Samantha Neumann ◽

Xiang Gao

Keyword(s):

Systematic Review ◽

Dose Response ◽

Prospective Studies ◽

Hemorrhagic Stroke ◽

Meta Analysis ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

Low Density ◽

Low Density Lipoprotein Cholesterol

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Assessment of cerebral autoregulation in stroke: A systematic review and meta-analysis of studies at rest

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x19871013 ◽

2019 ◽

Vol 39 (11) ◽

pp. 2105-2116 ◽

Cited By ~ 8

Author(s):

Kannakorn Intharakham ◽

Lucy Beishon ◽

Ronney B Panerai ◽

Victoria J Haunton ◽

Thompson G Robinson

Keyword(s):

Systematic Review ◽

Cerebral Autoregulation ◽

Hemorrhagic Stroke ◽

Function Analysis ◽

Meta Analysis ◽

Cerebrovascular Diseases ◽

Transfer Function Analysis ◽

Autoregulation Index ◽

Meta Analyses ◽

Dynamic Cerebral Autoregulation

Dynamic cerebral autoregulation (dCA) has been shown to be impaired in cerebrovascular diseases, but there is a lack of consistency across different studies and the different metrics that have been proposed for assessment. We performed a systematic review and meta-analyses involving assessment of dCA in ischemic and hemorrhagic stroke. Thirty-three articles describing assessment of dCA with transfer function analysis (TFA) were included, with meta-analyses performed for derived parameters of gain, phase and autoregulation index (ARI). A total of 1233 patients were pooled from 12 studies on acute ischemic stroke (AIS) and two studies on intracerebral hemorrhage (ICH). In comparison with controls, TFA phase of AIS was significantly reduced (nine studies), in both hemispheres ( P < 0.0001). TFA gain provided inconsistent results, with reduced values in relation to controls, for both hemispheres. The ARI (six studies) was reduced compared to controls, in both hemispheres ( P < 0.005). In ICH, gain showed higher values compared to controls for the unaffected ( P = 0.01), but not for the affected hemisphere. Meta-analyses in AIS have demonstrated that phase and the ARI index can show highly significant differences in comparison with healthy controls, while ICH have been limited by the scarcity of studies and the diversity of units adopted for gain.

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