J Korean Neurosurg Soc.  2020 Jul;63(4):455-462. 10.3340/jkns.2020.0036.

Arachnoid Plasty to Prevent and Reduce Chronic Subdural Hematoma after Clipping Surgery for Unruptured Intracranial Aneurysm : A Meta-Analysis

• Jang KM
• Choi HH
• Nam TK
• Park YS
• Kwon JT

• KMID: 2504639
• DOI: http://doi.org/10.3340/jkns.2020.0036

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 metaanalysis 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.

Keyword

Aneurysm; Surgery; Hematoma, Subdural, Chronic; Arachnoid

Figure

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  Fig. 1. Flow diagram for the selection of relevant studies.

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  Fig. 2. Efficacy of arachnoid plasty in the chronic subdural hematoma reduction after clipping surgery for unruptured intracranial aneurysm. OR : odds ratio, CI : confidence interval.

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  Fig. 3. Sensitivity analysis for arachnoid plasty efficacy, excluding the Kawase trial. OR : odds ratio, CI : confidence interval.

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  Fig. 4. Meta-regression analysis for male sex on postoperative chronic subdural hematoma development.

Reference

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