Extended lumbar drainage in idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis of diagnostic test accuracy.

Autor: Nunn AC; Department of Neurosurgery, Southmead Hospital, Bristol, UK., Jones HE; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK., Morosanu CO; Department of Neurosurgery, Southmead Hospital, Bristol, UK., Singleton WGB; Department of Neurosurgery, Southmead Hospital, Bristol, UK., Williams MA; Departments of Neurology and Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA.; Adult Hydrocephalus Clinical Research Network, Hydrocephalus Association, Bethesda, MD, USA., Nagel SJ; Adult Hydrocephalus Clinical Research Network, Hydrocephalus Association, Bethesda, MD, USA.; Department of Neurosurgery, Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA., Luciano MG; Adult Hydrocephalus Clinical Research Network, Hydrocephalus Association, Bethesda, MD, USA.; Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA., Zwimpfer TJ; Adult Hydrocephalus Clinical Research Network, Hydrocephalus Association, Bethesda, MD, USA.; Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, Canada., Holubkov R; Adult Hydrocephalus Clinical Research Network, Hydrocephalus Association, Bethesda, MD, USA.; Department of Pediatrics, University of Utah, Salt Lake City, UT, USA., Wisoff JH; Adult Hydrocephalus Clinical Research Network, Hydrocephalus Association, Bethesda, MD, USA.; Division of Pediatric Neurosurgery, Hassenfeld Children's Hospital at NYU Langone Health, New York, NY, USA., McKhann GM 2nd; Adult Hydrocephalus Clinical Research Network, Hydrocephalus Association, Bethesda, MD, USA.; Department of Neurological Surgery, Columbia University School of Medicine, New York, NY, USA., Hamilton MG; Adult Hydrocephalus Clinical Research Network, Hydrocephalus Association, Bethesda, MD, USA.; Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary School of Medicine, Calgary, Canada., Edwards RJ; Department of Neurosurgery, Southmead Hospital, Bristol, UK.; Adult Hydrocephalus Clinical Research Network, Hydrocephalus Association, Bethesda, MD, USA.
Jazyk: angličtina
Zdroj: British journal of neurosurgery [Br J Neurosurg] 2021 Jun; Vol. 35 (3), pp. 285-291. Date of Electronic Publication: 2020 Jul 09.
DOI: 10.1080/02688697.2020.1787948
Abstrakt: Background: When appropriately selected, a high proportion of patients with suspected idiopathic normal pressure hydrocephalus (iNPH) will respond to cerebrospinal fluid diversion with a shunt. Extended lumbar drainage (ELD) is regarded as the most accurate test for this condition, however, varying estimates of its accuracy are found in the current literature. Here, we review the literature in order to provide summary estimates of sensitivity, specificity, positive- and negative predictive value for this test through meta-analysis of suitably rigorous studies.
Methods: Studies involving a population of NPH patients with predominantly idiopathic aetiology (>80%) in which the intention of the study was to shunt patients regardless of the outcome of ELD were included in the review. Various literature databases were searched to identify diagnostic test accuracy studies addressing ELD in the diagnosis of iNPH. Those studies passing screening and eligibility were assessed using the QUADAS-2 tool and data extracted for bivariate random effects meta-analysis.
Results: Four small studies were identified. They showed disparate results concerning diagnostic test accuracy. The summary estimates for sensitivity and specificity were 94% (CI 41-100%) and 85% (CI 33-100%), respectively. The summary estimates of positive and negative predictive value were both 90% (CIs 65-100% and 48-100%, respectively).
Conclusion: Large, rigorous studies addressing the diagnostic accuracy of ELD are lacking, and little robust evidence exists to support the use of ELD in diagnostic algorithms for iNPH. Therefore, a large cohort study, or ideally an RCT, is needed to determine best practice in selecting patients for shunt surgery.
Databáze: MEDLINE
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