The incidence of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms by microsurgical clipping versus endovascular coiling: a systematic review

Abstract

Objective To systematically review the risk of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms by microsurgical clipping versus endovascular coiling.  Methods A comprehensive literature search from January 1990 to September 2015 was conducted in electronic databases, such as PubMed, EMBASE/SCOPUS, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI) and Wanfang data, for randomized controlled trials (RCTs) or observational studies. Key words were defined as hydrocephalus, shunt, clipping, coiling, surgical, endovascular, embolization, treatment, intracranial aneurysm, cerebral aneurysm, subarachnoid hemorrhage both in Chinese and English. Manual search was also conducted on several relevant journals, such as Chinese Journal of Neurosurgery, Chinese Journal of Contemporary Neurology and Neurosurgery, Chinese Journal of Cerebrovascular Diseases, and so on. Data were extracted and evaluated by two reviewers independently. Jadad Scale was used to assess the quality of RCTs. Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of nonrandomized controlled trials. RevMan 5.3 and Stata 13.1 were used for Meta-analysis.  Results Eighteen observational studies were finally included, involving 15 920 patients with ruptured intracranial aneurysms, among whom 10 038 patients underwent clipping and 5882 underwent coiling. The result of Meta-analysis indicated that there was no statistical significance on the incidence of shunt-dependent hydrocephalus between clipping and coiling (OR = 0.860, 95%CI: 0.720-1.030; P = 0.110). However, the findings showed low stability as the results of fixed effects model and random effects model were different. The result of Egger's test indicated no publication bias (P = 0.795).  Conclusions The frequency of shunt-dependent hydrocephalus was not significantly different between clipping and coiling. However, the conclusion still needs to be further verified by high-quality studies.

DOI: 10.3969/j.issn.1672-6731.2016.02.003