Quantifying the risks: a systematic review and proportional meta-analysis of the perioperative complications of posterior cranial vault distraction osteogenesis in patients with craniosynostosis
Notice bibliographique
Résumé
OBJECTIVE: Posterior cranial vault distraction osteogenesis (PCVDO) is a well-established surgical technique for increasing intracranial volume and correcting cranial deformities in children with craniosynostosis. Despite its efficacy, PCVDO is associated with the risk for several perioperative complications. In this systematic review and proportional meta-analysis, the authors aimed to estimate the pooled prevalence of complications associated with PCVDO, including overall complications, infection, CSF leakage, device-related complications, premature device removal, and unplanned returns to the operating room. Additionally, they sought to identify sources of heterogeneity among the studies and evaluate the influence of key clinical and surgical moderators-such as patient age, syndromic status, distraction parameters, elevated intracranial pressure, hydrocephalus, Chiari malformation, syrinx, and prior surgical interventions-on complication rates. METHODS: A systematic review and proportional meta-analysis were conducted, following the PRISMA guidelines. The MEDLINE/PubMed database was reviewed for English-language, peer-reviewed studies published between 2009 and 2025 that reported perioperative complications in pediatric patients (age < 18 years) with craniosynostosis who had undergone PCVDO and included at least 2 patients. Excluded publications were single case reports, editorials, technical notes, reviews, preclinical or animal studies, and studies not meeting these criteria. Data from the included studies were compiled into a comprehensive spreadsheet to facilitate qualitative and quantitative analyses. A quality assessment of all studies was conducted utilizing the Newcastle-Ottawa Scale. The primary outcome was the proportion of patients experiencing any complication. Secondary outcomes comprised rates of infection and wound-related events, CSF leakage, device-related complications, premature device removal, and unplanned returns to the operating room. RESULTS: Thirty-three studies were included in this analysis. The pooled overall complication rate was 26.3%. Infection and wound-related complications were most common (10.4%), followed by CSF leakage (6.7%) and device-related complications (6.0%). Premature device removal and return to the operating room occurred in 4.0% and 9.9% of patients, respectively. Meta-regression analysis revealed that younger age was significantly associated with an increased risk of CSF leakage and premature device removal. Shorter latency periods were associated with a higher risk of CSF leakage and return to the operating room. CONCLUSIONS: While PCVDO is effective in managing craniosynostosis, it is associated with a considerable risk of complications. Age and latency period are significant predictors of adverse outcomes. Innovations in device design and surgical protocols are warranted to optimize the safety and efficacy of the procedure.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,023 | 0,052 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,017 | 0,049 |
| Bibliométrie | 0,008 | 0,008 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».