Effectiveness of preoperative shaving and postoperative shampooing on the infection rate in neurosurgery patients: A meta-analysis.

OBJECTIVE: To evaluate the effectiveness of preoperative shaving and postoperative shampooing on the infection rate in neurosurgery. DESIGN: Meta-analysis. DATA SOURCE: We conducted a search of the Embase, CINAHL, Scopus and PubMed databases up until February 1, 2022. Comparative studies were included. No language restrictions were applied. REVIEW METHODS: Original articles that compared the infection rate of patients who had their hair shaved before neurosurgery to the infection rate of unshaven patients were included. Original articles comparing the infection rates of patients whose hair was early postoperative shampooing versus patients whose hair was not shampooed after neurosurgery were also included. The risk of bias was also evaluated using the Newcastle-Ottawa quality assessment scale by two authors independently. The meta-analyses were performed using Review Manager software (RevMan 5.3; Cochrane Collaboration). The odds ratios (ORs) and 95% confidence intervals (CIs) were assessed for dichotomous data (infection rate). The heterogeneity of the included studies was assessed using the I2 statistic (ranging from 0 to 100%). RESULTS: A total of 3451 studies were identified by searching the PubMed, Scopus, CINAHL and Embase databases. Fourteen studies met the inclusion criteria, however two studies did not provide data suitable for meta-analysis. Twelve studies were included in the review. Two historical control studies, four prospective studies, one clinical trial and five retrospective studies were identified. There were 4583 patients whose hair was not shaved and 4295 patients whose hair was shaved. Among them, there were 3874 patients whose hair was unshaved and was early postoperative shampooing. No significant difference in the infection rate was found between the unshaved group and shaved group (OR: 0.86, 95% CI [0.62, 1.19], P = 0.85, I2 = 0%). A significant difference in the infection rates in shunt surgery patients was found between the unshaved group and shaved group (OR: 0.43, 95% CI [0.19, 0.99], P = 0.89, I2 = 0%). No significant difference was found between the unshaved with early shampooing group and the shaved group (OR: 0.82, 95% CI [0.48, 1.41], P = 0.80, I2 = 0%). CONCLUSION: Hair preservation before neurosurgery and early shampooing after neurosurgery did not increase the infection rate.

[The clinical features and perioperational managements of craniopharyngiomas in posterior fossa].

OBJECTIVE: To investigate the clinical features and perioperational managements of craniophayngiomas located in posterior fossa. METHODS: Nine patients with craniopharyngioma situated in posterior fossa were included in the study. The clinical manifestations, neuroimage features, operational treatment, and perioperational managments were retrospectively analyzed. RESULTS; All tumors associated with big or huge volume, arised from sellar/suprasellar region and extended into posterior fossa. Tumors showed cystic lesions in 2 cases and cystic-solid lesions in 7 cases. Headache was the most common symptoms (6/9), followed by cranial nerve deficit (4/9) and endocrine dysfunction(3/9). The supra- and infra-tentorial approaches were the optimal approaches for removal these tumors (7/9). Cranial nerves deficit was the most common complication in perioperative period. No perioperational death occured, most of the patients showed good recovery during the fellow-up period. CONCLUSION: Craniophayngiomas in posterior fossa shows different clinical manifestations, radiological features, surgical complications to the tumor in sellar/suprasellar region.

Characteristics of circadian rhythm in patients with intracerebral hemorrhage before death.

OBJECTIVE: To investigate characteristics of circadian rhythm in intracerebral hemorrhage before death. METHODS: This retrospective study was carried out from September 2002 to February 2009. One hundred and twenty-two dead cases with intracerebral hemorrhage(ICH) were collected. The study was carried out in the Department of Neurosurgery in The Second Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China. Blood pressure (BP) and heart rate (HR) were recorded every half-hour during the 72 hours before death. Data of BP and HR before deaths were divided into 3 time periods, namely, period A (72-48 hours to death), period B (48-24 hours to death), and period C (24 hours to death). Data from the 3 periods were analyzed using the Cosinor method to determine whether circadian rhythm was present or absent. The cases were divided into a present and absent group after Cosinor analysis. Prognostic factors in the 2 groups were analyzed by Student`s t-test and Pearson`s chi-squared test. RESULTS: Significant differences in prognostic factors between the 2 groups were not found. When circadian midline-estimating statistic of rhythms over the 3 periods were compared, there were no significant differences. However, when circadian amplitudes over the 3 periods were compared, the amplitudes during period C were significantly lower than period A or B (p<0.001). The percentage of cases in the absent and present groups was significantly different (p<0.001) over the 3 periods. CONCLUSION: As an independent factor, circadian variation could predict death in patients with ICH.