• Lucca Biolcati Palavani, Luis Bandeira Alves Neto, Sávio Batista, Márcio Yuri Ferreira, Déborah Emmily de Carvalho, Guilherme de Vasconcellos Piscoya, Caio Teodoro Ramos Cabral Angelim Frazão, João Gabriel Alves Leite, Matheus Queiroga Fernandes, Vieira NogueiraBernardoBSerra dos Orgaos University Center, Brazil., Daniel Augustin Godoy, Sergio Brasil, Andres Mariano Rubiano, Raphael Bertani de Magalhães, and Wellingson Silva Paiva.
• Max Planck University, Brazil. Electronic address: lucca.palavani730@alunieduk.com.br.
• World Neurosurg. 2024 Oct 1; 190: 768776-87.

AbstractThe use of invasive or noninvasive intracranial pressure (ICP) monitoring post-decompressive craniectomy (DC) has been a continuous matter of debate. Accordingly, this meta-analysis aims to examine the existing evidence of both approaches and compare their impact among patients undergoing DC, guiding clinical decision-making in the management of elevated ICP. The databases used were Pubmed, Cochrane, Web of Science, and Embase. Inclusion criteria included: (1) English studies; (2) randomized and nonrandomized studies; (3) reporting on invasive OR noninvasive ICP monitoring after DC; (4) with at least one of the outcomes of interest: incidence of mortality, new cerebral hemorrhages, and the Glasgow Outcome Scale. The study followed the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Thirty-six studies were included in this meta-analysis, resulting in a sample of 1624 patients. One thousand two hundred eighty-six underwent invasive monitoring, and 338 underwent noninvasive methods. In the invasive group, a mortality rate of 17% (95% confidence interval [CI]: 12%-22%), a good outcome rate of 58% (95% CI: 38%-49%), a poor outcome rate of 42% (95% CI: 21%-62%), and an overall incidence of new hemorrhages of 4% (95% CI: 0%-8%) were found. Whereas in the noninvasive sample, a mortality rate of 20% (95% CI: 15%-26%) and a good outcome rate of 38% (95% CI: 25%-52%) were obtained. It seems that the effectiveness of invasive and noninvasive ICP monitoring methods are comparable in post-DC patients. While invasive monitoring remains gold standard, noninvasive methods offer a safer and cost-effective alternative, potentially improving post-DC patient care, and can mostly be used simultaneously with invasive methods.Copyright © 2024 Elsevier Inc. All rights reserved.

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