Abstract Details

Title Hypertonic Saline Solution Versus Mannitol for Brain Relaxation During Craniotomies: An Updated Meta-analysis

Topic Neuro-oncology

Presentation(s) P4 - Poster Session 4 (11:45 AM-12:45 PM)

Poster/Presentation
Number 5-003

Objective This meta-analysis intends to provide an updated review of the published literature by comprising the largest published to date on the comparison of HTS with MAN for brain relaxation during craniotomies.

Background The choice between mannitol and hypertonic saline as the preferred osmotic agent for achieving brain relaxation during craniotomies still lacks a definitive consensus in the existing body of research. This lack of agreement can be attributed to limited sample sizes and substantial heterogeneity among the trials included in previous studies.

Design/Methods MEDLINE, Embase, and Cochrane databases were systematically searched until August 02, 2023. Data was examined using the Mantel-Haenszel method and 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics. Meta-regression analysis was conducted to evaluate a possible link between Brain Relaxation Score (BRS) and tumor volume. R, version 4.2.3, was used for statistical analysis.

Results A total of 16 RCTs and 1,031 patients were included, of whom 631 (61%) underwent surgery for supratentorial tumor resection. Compared with mannitol, hypertonic saline achieved better rates of BRS (80% vs. 71%; OR 1.68; 95% CI 1.22–2.33; p=0.001; I²=0%), which was also demonstrated in the subgroup analysis of supratentorial brain tumor patients (78% vs. 65%; OR 2.02; 95% CI 1.36–2.99; p=0.0005; I²=0%); a minor number of patients requiring a second dose of osmotic agent (14% vs. 28%; OR 0.43; 95% CI 0.27–0.69; p=0.0003; I²= 0%); a lower fluid intake (MD -475.9341 mL; 95% CI -818.8952– -132.9730; p=0.007; I²=88%); and lower urine output (MD -462.0941 mL; 95% CI -585.3020– -338.8862; p=<0.001; I²=96%). Hospital length of stay and focal neurological deficits did not reach a statistically significant difference.

Conclusions Our study shows that HTS has better benefits than mannitol, not only for brain relaxation. Furthermore, the study reveals, utilizing subgroup analysis, that patients with supratentorial brain tumors are more likely to benefit from HTS administration.

Authors/Disclosures
Artur Menegaz de Almeida, MS PRESENTER	Mr. Menegaz de Almeida has nothing to disclose.
Patricia Viana	No disclosure on file
Gabriel Marinheiro Dos Santos-Bezerra	Gabriel Marinheiro Dos Santos-Bezerra has nothing to disclose.
Jessica Hoffmann Relvas	No disclosure on file
Lucca Moreira Lopes	No disclosure on file
Gustavo L. Guilherme, Sr.	Mr. Guilherme has nothing to disclose.
João A. Zanette Giusti	Mr. Zanette Giusti has nothing to disclose.
Paloma Oliveira	No disclosure on file
Mauro André Cabral	No disclosure on file
Renato Carvalho Santos	No disclosure on file
Khalid Medani, MD (UCLA)	Dr. Medani has nothing to disclose.

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