Systematic review and meta-analysis of the efficacy and safety of cerebrospinal fluid drainage and lumbar puncture in the treatment of cerebrospinal fluid leakage after craniocerebral injury

Abstract

Background: Commonly used clinical treatments for intracranial hypertension include continuous lumbar cerebrospinal fluid drainage (CLCFD) and conventional lumbar puncture. However, lumbar puncture is more invasive, requires multiple punctures. CLCFD has less trauma, and drainage can be manipulated to avoid repeated lumbar puncture. However, CLCFD may also lead to complications such as intracranial hematoma and intracranial pneumothorax. Therefore, there is no agreement on which method is more effective. This study evaluated the efficacy of CLCFD and conventional lumbar puncture in the treatment of cerebrospinal fluid leakage after craniocerebral injury. Methods: The search terms 'brain injury' and 'CLCFD' were used to search CNKI, Wanfang, VIP, Longyuan, PubMed, Embase, Cochrane Library and other databases (from inception to November 1, 2022). Inclusion criteria: (I) randomized controlled trials (RCTs), CLCFD and conventional lumbar puncture drainage for patients with cerebrospinal fluid leakage after craniocerebral injury; (II) evaluation of indicators such as cerebrospinal fluid leakage stop time, clearance time, intracranial infection and complications.Cochrane systematic review was performed to assess the quality of the literature. RevMan 5.3 software was used for systematic analysis.Results: A total of 8 studies, involving 568 patients. There is some publication bias in the statistics.The cessation time of cerebrospinal fluid leakage (95% confidence interval (CI): −3.65 to −2.86, Z=16.21, P<0.00001), the time to return to normal pressure (95% CI: −3.13 to −2.09, Z=9.79, P<0.00001), cerebrospinal fluid clearing time (95% CI: −1.96 to −1.09, Z=6.91, P<0.00001), hospitalization time (95% CI: −1.99 to −0.91, Z=5.27, P<0.00001), incidence of intracranial infection (95% CI: 0.07-0.27, Z=5.84, P<0.00001) and complications (95% CI: 0.10-0.43, Z=4.22, P<0.0001) in the CLCFD group were lower than those in the conventional group. The cure rate of the CLCFD group was significantly higher than that of the conventional group (OR =3.75, 95% CI: 2.26-6.23, Z=5.11, P<0.00001); the difference in mortality between the two groups was not statistically significant (P>0.05).Conclusions: Compared with conventional lumbar puncture, CLCFD can significantly increase the cure rate, shorten the recovery time of cerebrospinal fluid, and significantly reduce the incidence of intracranial infections, reduce complications, is conducive to the prognosis of patients.