Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Arachnoid Plasty to Prevent and Reduce Chronic Subdural Hematoma after Clipping Surgery for Unruptured Intracranial Aneurysm : A Meta-Analysis

  • Jang, Kyoung Min (Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Choi, Hyun Ho (Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Nam, Taek Kyun (Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Park, Yong Sook (Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Kwon, Jeong Taik (Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine)
  • Received : 2020.02.11
  • Accepted : 2020.03.03
  • Published : 2020.07.01
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Abstract

Objective : Recent studies have reported that arachnoid plasty (ARP) using gelatin sponges with fibrin glue reduced the occurrence of chronic subdural hematoma (CSDH) following clipping surgery for unruptured intracranial aneurysm (UIA). This meta-analysis was conducted to collate further evidence for the efficacy of ARP in preventing postoperative CSDH. Methods : Data of patients who underwent clipping surgery were extracted from PubMed, EMBASE, and Cochrane Central Register of Controlled Trials by two independent reviewers. A random effects model was used to investigate the efficacy of ARP by using odd ratios (ORs) and 95% confidence intervals (CIs). A meta-regression analysis for male sex was additionally preformed. Results : Data from six studies with 1715 patients were consecutively included. Meta-analysis revealed that ARP was significantly associated with lower rates of CSDH development after surgical clipping for UIA (ARP group vs. control group : 3.2% vs. 7.2%; OR, 0.40; 95% CI, 0.18-0.93; I2=44.3%; p=0.110). Meta-regression analysis did not highlight any modifying effect of the male sex on postoperative CSDH development (p=0.951). Conclusion : This meta-analysis indicated that ARP reduced the incidence rates of CSDH following clipping surgery for UIA. If feasible, ARP would be implemented as an additional surgical technique to prevent postoperative CSDH development during surgical clipping of UIA.

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References

  1. Desai VR, Scranton RA, Britz GW : Management of recurrent subdural hematomas. Neurosurg Clin N Am 28 : 279-286, 2017 https://doi.org/10.1016/j.nec.2016.11.010
  2. Gazzeri R, Galarza M, Neroni M, Alfieri A, Giordano M : Hemostatic matrix sealant in neurosurgery: a clinical and imaging study. Acta Neurochir (Wien) 153 : 148-155, 2011 https://doi.org/10.1007/s00701-010-0762-y
  3. Inamasu J, Watabe T, Ganaha T, Yamada Y, Nakae S, Ohmi T, et al. : Clinical characteristics and risk factors of chronic subdural haematoma associated with clipping of unruptured cerebral aneurysms. J Clin Neurosci 20 : 1095-1098, 2013 https://doi.org/10.1016/j.jocn.2012.09.024
  4. Jung YJ, Ahn JS, Park ES, Kwon DH, Kwun BD, Kim CJ : Surgical results of unruptured intracranial aneurysms in the elderly : single center experience in the past ten years. J Korean Neurosurg Soc 49 : 329-333, 2011 https://doi.org/10.3340/jkns.2011.49.6.329
  5. Kang JH, Huh SK, Kim J, Park KY, Chung J : Subdural fluid collection after the clipping of unruptured intracranial aneurysms: its clinical course and significance. World Neurosurg 116 : e266-e272, 2018 https://doi.org/10.1016/j.wneu.2018.04.185
  6. Kawabata S, Tani S, Imamura H, Adachi H, Sakai N : Postoperative subdural air collection is a risk factor for chronic subdural hematoma after surgical clipping of cerebral aneurysms. Neurol Med Chir (Tokyo) 58 : 247-253, 2018 https://doi.org/10.2176/nmc.oa.2018-0019
  7. Kawase T, Bishnoi I, Tanaka R, Dash C, Kato Y, Yamada Y : Study of incidence and factors: risk and preventive, of chronic subdural hematoma/hygroma in clipped patients of unruptured intracranial aneurysms - an institutional experience. Asian J Neurosurg 13 : 707-713, 2018
  8. Kim JH, Kim CH, Lee CY : Efficacy of arachnoid-plasty on chronic subdural hematoma following surgical clipping of unruptured intracranial aneurysms. World neurosurgery 104 : 303-310, 2017 https://doi.org/10.1016/j.wneu.2017.04.162
  9. Kwon MY, Kim CH, Lee CY : Predicting factors of chronic subdural hematoma following surgical clipping in unruptured and ruptured intracranial aneurysm. J Korean Neurosurg Soc 59 : 458-465, 2016 https://doi.org/10.3340/jkns.2016.59.5.458
  10. Lee KS : The pathogenesis and clinical significance of traumatic subdural hygroma. Brain Inj 12 : 595-603, 1998 https://doi.org/10.1080/026990598122359
  11. Lee WJ, Jo KI, Yeon JY, Hong SC, Kim JS : Incidence and risk factors of chronic subdural hematoma after surgical clipping for unruptured anterior circulation aneurysms. J Korean Neurosurg Soc 57 : 271-275, 2015 https://doi.org/10.3340/jkns.2015.57.4.271
  12. Lee WJ, Nam TM, Jo KI, Yeon JY, Hong SC, Kim JS : Modified arachnoid plasty reduces chronic subdural hematoma after unruptured aneurysm clipping : technical note. J Korean Neurosurg Soc 61 : 761-766, 2018 https://doi.org/10.3340/jkns.2017.0242
  13. Mino Y, Hirashima Y, Hamada H, Masuoka T, Yamatani K, Takeda S, et al. : Effect of arachnoid plasty using fibrin glue membrane after clipping of ruptured aneurysm on the occurrence of complications and outcome in the elderly patients. Acta neurochirurgica (Wien) 148 : 627-631; discussion 631, 2006 https://doi.org/10.1007/s00701-006-0777-6
  14. Murakami T, Nakagawa I, Park HS, Kotsugi M, Takamura Y, Takeshima Y, et al. : Extensive postoperative subdural fluid volume affects the onset of chronic subdural hematoma after unruptured aneurysmal clipping surgery. Clin Neurol Neurosurg 187 : 105533, 2019 https://doi.org/10.1016/j.clineuro.2019.105533
  15. Ohno T, Iihara K, Takahashi JC, Nakajima N, Satow T, Hishikawa T, et al. : Incidence and risk factors of chronic subdural hematoma after aneurysmal clipping. World Neurosurg 80 : 534-537, 2013 https://doi.org/10.1016/j.wneu.2012.09.025
  16. Park J, Cho JH, Goh DH, Kang DH, Shin IH, Hamm IS : Postoperative subdural hygroma and chronic subdural hematoma after unruptured aneurysm surgery: age, sex, and aneurysm location as independent risk factors. J Neurosurg 124 : 310-317, 2016 https://doi.org/10.3171/2015.1.jns14309
  17. Schardt C, Adams MB, Owens T, Keitz S, Fontelo P : Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak 7 : 16, 2007 https://doi.org/10.1186/1472-6947-7-16
  18. Sundstrom T, Helland CA, Aarhus M, Wester K : What is the pressure in chronic subdural hematomas? A prospective, population-based study. J Neurotrauma 29 : 137-142, 2012 https://doi.org/10.1089/neu.2011.1776
  19. Tsuruno T : An arachnoid plasty technique using a collagen seat and fibrin glue. Jpn J Neurosurg (Tokyo) 4 : 193-195, 1995 https://doi.org/10.7887/jcns.4.193
  20. Yagi K, Irie S, Inagaki T, Ishii Y, Saito O, Lee T, et al. : Intraoperative arachnoid plasty has possibility to prevent chronic subdural hematoma after surgery for unruptured cerebral aneurysms. Neurol Med Chir (Tokyo) 55 : 493-497, 2015 https://doi.org/10.2176/nmc.oa.2014-0455
  21. Yamamoto H, Hirashima Y, Hamada H, Hayashi N, Origasa H, Endo S : Independent predictors of recurrence of chronic subdural hematoma: results of multivariate analysis performed using a logistic regression model. J Neurosurg 98 : 1217-1221, 2003 https://doi.org/10.3171/jns.2003.98.6.1217
  22. Yoshimoto Y, Wakai S, Hamano M : External hydrocephalus after aneurysm surgery: paradoxical response to ventricular shunting. J Neurosurg 88 : 485-489, 1998 https://doi.org/10.3171/jns.1998.88.3.0485