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'''Postoperative hyperbaric oxygen reduced neurological deficit, brain oedema and abnormal brain density on C/T imaging following resection of meningiomas with associated brain oedema. '''
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| '''1. Hyperbaric oxygen reduced the incidence of neurological deficit at six months after resection''' **2. Hyperbaric oxygen reduced the measured volume of oedematous brain at 15 days postoperatively and of the volume of ''' '''encephalomalacia at six months.''' 
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'''Citation/s:'''1. Tang X, Yin X, Zhang T, Peng H. The effect of hyperbaric oxygen therapy on clinical outcomes of patients after resection of meningiomas with conspicuous peritumoral brain edema. Undersea and Hyperbaric Medicine 2011;38(2):109-115. 
'''Lead author's name and email''': Xiaoping Tang: [[mailto:Tangxp1971@gmail.com | Tangxp1971@gmail.com]] 

'''Three-part Clinical Question:''' For patients with meningiomas associated with significant brain oedema, does postoperative hyperbaric oxygen therapy result in improved clinical outcome? 
'''Search Terms:''' meningioma, brain oedema, Karnofsky score 

'''The Study:''' Non-blinded concealed randomised controlled trial, intention-to-treat unclear.
'''The Study Patients:''' Adult patients with resectable, supratentorial meningiomas where significant brain oedema is shown preoperatively on C/T or MRI. 
Control group (N = 116; 116 analysed): Standard operative and postoperative care with resection, dehydration, anti-epileptic drugs, antibiotics and symptom relief 
Experimental group (N = 116; 116 analysed): As above plus postoperative HBOT at 2ATA for 20 minutes daily to a total of 20 sessions. 

**The Evidence:'''
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| '''Outcome ''' || '''Time to Outcome ''' || '''Control group''' || '''HBO group''' || '''Relative risk reduction ''' || '''Absolute risk reduction''' || '''Number needed to treat'''
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| '''Proportion with neurological deficits or epilepsy''' || 6 months || 0.24 || 0.13 || 46% || 0.11 || 9
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|^ |||||| 95% CIs:: || 5% to 88% || 0.01 to 0.21 || 5 to 76
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{|
| '''Outcome''' |||| '''Control Group''' |||| '''HBO Group''' |||| '''Difference''' || '''95% CI'''
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|^ || '''Mean''' || '''SD''' || '''Mean''' |||| '''SD''' || ||^
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| '''Karnofsky Performance Score at 15 days ''' || 88.4 || 15.0 || 95.4 |||| 15.6 || 7.0 || -53.8 to 67.8
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| '''Brain oedema volume at 15 days (cm3)''' || 47.1 || 6.4 || 34.6 |||| 5.2 || 12.5 || 3.7 to 21.3
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| '''Encephalomalacia volume at six months (cm3)''' || 13.9 || 3.7 || 9.0 |||| 2.3 || 4.9 || 2.4 to 7.4
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**Comments:'''
1. Unusual method of randomisation, but probably effective and with allocation concealment.
2. There was no description of power or sample size calculations
3. No information of the numbers of patients who did not complete the course of HBOT, suffered complications or on the numbers who were assessed in first 15 days.
4. Karnofsky score at 15 days was reported as significantly different between groups in the paper, but not with our calculations for this appraisal.
5. These interesting findings would need to be replicated before being HBOT could be established as routine. More information is required on any complications of therapy. 

'''Appraised by:''' Mike Bennett: m.bennett@unsw.edu.au ; Friday, 5 October 2012
'''Kill or Update By:''' June 2020

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