Cranioplasty Infection and Resorption Are Associated with the Presence of a Ventriculoperitoneal Shunt: A Systematic Review and Meta-Analysis

Background Following decompressive craniectomy, hydrocephalus is a common complication often necessitating placement of a ventriculoperitoneal shunt (VPS). Complications in the presence of a VPS have been reported, but a clear association has not been established. Methods PRISMA guidelines were used to perform a literature search using PubMed to identify articles that published the complication rates associated with staged or simultaneous cranioplasty and VPS placement. From these event rates, odds ratios (ORs) with 95% confidence intervals (CIs) of complications were calculated. Data were pooled using the Mantel–Haenszel method. The Oxford Center for Evidence-Based Medicine guidelines were used to assess the quality of individual articles and studies. The Newcastle–Ottawa Scale was used to assess the risk of bias in studies. Results Of the 30 papers reviewed for complications in the presence and absence of a VPS, 7 studies, with a total of 1635 patients, were eligible for meta-analysis. Overall rates of complications (n = 1635; OR, 9.75; 95% CI, 4.8–20.1), infection (OR, 4.9; 95% CI, 2.2–10.7), and bone resorption (OR, 10.6; 95% CI, 4.9–23.0) were increased when a VPS was placed at the time of cranioplasty. Simultaneous procedures were associated with increased complication rates (n = 283; OR, 4.3; 95% CI, 2.3–8.2) compared with staged procedures. Conclusions Cranioplasty in the presence of a VPS is associated with a higher rate of overall complications, including infection and bone resorption. Performing cranioplasty and VPS placement in the same operation is associated with an increased rate of complications compared with staged procedures. Surgeons should consider staging these procedures when possible and counsel patients about these risks.