Prognostic Utility of Disproportionately Enlarged Subarachnoid Space Hydrocephalus in Idiopathic Normal Pressure Hydrocephalus Treated with Ventriculoperitoneal Shunt Surgery: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
H.Y. Park ◽  
C.R. Park ◽  
C.H. Suh ◽  
M.J. Kim ◽  
W.H. Shim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Subarachnoid Space ◽  
Meta Analysis ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Shunt Surgery ◽  
Prognostic Utility

scholarly journals The effect of shunt surgery on neuropsychological performance in normal pressure hydrocephalus: a systematic review and meta-analysis

2016 ◽  
Vol 263 (8) ◽  
pp. 1669-1677 ◽  
Author(s):  
Katie A. Peterson ◽  
George Savulich ◽  
Dan Jackson ◽  
Clare Killikelly ◽  
John D. Pickard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Normal Pressure Hydrocephalus ◽  
Meta Analysis ◽  
Normal Pressure ◽  
Neuropsychological Performance ◽  
Shunt Surgery

scholarly journals Timed up and go test at tap test and shunt surgery in idiopathic normal pressure hydrocephalus

2017 ◽  
Vol 7 (2) ◽  
pp. 98-108 ◽  
Author(s):  
Shigeki Yamada ◽  
Masatsune Ishikawa ◽  
Masakazu Miyajima ◽  
Madoka Nakajima ◽  
Masamichi Atsuchi ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Shunt Surgery ◽  
Timed Up And Go ◽  
Tap Test ◽  
Lumboperitoneal Shunt ◽  
Shunt Implantation ◽  
Percent Improvement

AbstractBackground:The 3-meter Timed Up and Go test (TUG) is a reliable quantitative test for assessment of gait and balance. We aimed to establish an optimal threshold of TUG at the tap test for predicting outcomes 12 months after shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH).Methods:The TUG was measured in a total of 151 patients with possible iNPH before and after a tap test and 12 months after shunt surgery. Among them, 81 patients underwent ventriculoperitoneal shunt implantation (SINPHONI) and 70 underwent lumboperitoneal shunt implantation (SINPHONI-2). The areas under the curve (AUCs), sensitivities, and specificities for predicting shunt effectiveness were assessed.Results:The simple differences of time on TUG at the tap test were significantly more accurate for predicting shunt effectiveness than percent improvement of time. The highest AUC for the synchronized moving cutoff point of TUG time was 0.81 (sensitivity 81.0%; specificity 81.6%) at the threshold of 5 seconds in the SINPHONI-2. For predicting improvements of ≥10 seconds 12 months after lumboperitoneal shunt implantation, the AUC was 0.90, and the sensitivity and specificity at the threshold of 5.6 seconds were 83.3% and 81.0%. Only for patients with a <5-second improvement at the tap test, ventriculoperitoneal shunt implantation conveyed significantly better improvements in TUG time 12 months after surgery than lumboperitoneal shunt implantation.Conclusions:An improvement of 5 seconds was a useful threshold of TUG time at the tap test for predicting a ≥10-second improvement 12 months after shunt surgery, rather than the percent improvement of TUG time.

scholarly journals Outcomes and complications of different surgical treatments for idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis

2019 ◽  
Vol 131 (4) ◽  
pp. 1024-1036 ◽  
Author(s):  
Enrico Giordan ◽  
Giorgio Palandri ◽  
Giuseppe Lanzino ◽  
Mohammad Hassan Murad ◽  
Benjamin D. Elder
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Normal Pressure Hydrocephalus ◽  
Revision Surgery ◽  
Meta Analysis ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Ovid Medline ◽  
Csf Diversion ◽  
Programmable Valves

OBJECTIVEDifferent CSF diversion procedures (ventriculoperitoneal, ventriculoatrial, and lumboperitoneal shunting) have been utilized for the treatment of idiopathic normal pressure hydrocephalus. More recently, endoscopic third ventriculostomy has been suggested as a reasonable alternative in some studies. The purpose of this study was to perform a systematic review and meta-analysis to assess overall rates of favorable outcomes and adverse events for each of these treatments. An additional objective was to determine the outcomes and complication rates in relation to the type of valve utilized (fixed vs programmable).METHODSMultiple databases (PubMed, Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus) were searched for studies involving patients with idiopathic ventriculomegaly, no secondary cause of hydrocephalus, opening pressure < 25 mm Hg on high-volume tap or drainage trial, and age > 60 years. Outcomes included the proportion of patients who showed improvement in gait, cognition, and bladder function. Adverse events considered in the analysis included postoperative ischemic/hemorrhagic complications, subdural fluid collections, seizures, need for revision surgery, and infection.RESULTSA total of 33 studies, encompassing 2461 patients, were identified. More than 75% of patients experienced improvement after shunting, without significant differences among the different techniques utilized. Overall, gait improvement was observed in 75% of patients, cognitive function improvement in more than 60%, and improvement of incontinence in 55%. Adjustable valves were associated with a reduction in revisions (12% vs 32%) and subdural collections (9% vs 22%) as compared to fixed valves.CONCLUSIONSOutcomes did not differ significantly among different CSF diversion techniques, and overall improvement was reported in more than 75% of patients. The use of programmable valves decreased the incidence of revision surgery and of subdural collections after surgery, potentially justifying the higher initial cost associated with these valves.

Systematic review of the outcome of shunt surgery in idiopathic normal-pressure hydrocephalus

2013 ◽  
Vol 155 (10) ◽  
pp. 1977-1980 ◽  
Author(s):  
Ahmed K. Toma ◽  
Marios C. Papadopoulos ◽  
Simon Stapleton ◽  
Neil D. Kitchen ◽  
Laurence D. Watkins
Keyword(s):  
Systematic Review ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Shunt Surgery

scholarly journals Clinical predictors of shunt response in the diagnosis and treatment of idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Santhosh G. Thavarajasingam ◽  
Mahmoud El-Khatib ◽  
Mark Rea ◽  
Salvatore Russo ◽  
Johannes Lemcke ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Test ◽  
Normal Pressure Hydrocephalus ◽  
Meta Analysis ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Future Research ◽  
Clinical Predictors ◽  
Timed Up And Go ◽  
Shunt Response

Abstract Background Positive shunt response (SR) remains the gold standard for diagnosing idiopathic normal pressure hydrocephalus (iNPH). However, multiple pathologies mimic iNPH symptoms, making it difficult to select patients who will respond to shunt surgery. Although presenting features, extended lumbar drainage (ELD), infusion test (IT), intracranial pressure monitoring (ICPM), and tap test (TT) have been used to predict SR, uncertainty remains over which diagnostic test to choose. Objective To conduct a systematic review and meta-analysis to identify clinical predictors of shunt responsiveness, evaluate their diagnostic effectiveness, and recommend the most effective diagnostic tests. Methods Embase, MEDLINE, Scopus, PubMed, Google Scholar, and JSTOR were searched for original studies investigating clinical predictors of SR in iNPH patients. Included studies were assessed using the QUADAS-2 tool, and eligible studies were evaluated using univariate and bivariate meta-analyses. Results Thirty-five studies were included. Nine studies discussed the diagnostic use of presenting clinical features, 8 studies ELD, 8 studies IT, 11 studies ICPM, and 6 studies TT. A meta-analysis of 21 eligible studies was conducted for TT, ELD, IT, and ICPM. ICPM yielded the highest diagnostic effectiveness, with diagnostic odds ratio (DOR) = 50.9 and area under curve (AUC) = 0.836. ELD yielded DOR = 27.70 and AUC = 0.753, IT had DOR = 5.70 and AUC = 0.729, and TT scored DOR = 3.86 and AUC = 0.711. Conclusion Intraparenchymal ICPM is statistically the most effective diagnostic test, followed by ELD, IT, and lastly TT. Due to the higher accessibility of TT and IT, they are recommended to be used first line, using a timed-up-and-go improvement ≥ 5.6 s or a Rout cut-off range between 13 and 16 mmHg, respectively. Patients who test negative should ideally be followed up with ICPM, using mean ICP wave amplitude $$\ge$$ ≥ 4 mmHg, or 1- to 4-day ELD with an MMSE cut-off improvement $$\ge$$ ≥ 3. Future research must use standardized methodologies for each diagnostic test and uniform criteria for SR to allow better comparison.

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