Article type
Abstract
"Background: Idiopathic normal pressure hydrocephalus(iNPH) shunting is commonly and widely used for the iNPH patients. However, evidence comparing the relative effectiveness, safety and certainty among different iNPH shunting is still lacking.
Objectives: This study aims to determine the effectiveness and safety of iNPH shunting.
Method: In this system review, we systematically searched PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science that compared iNPH shunting from inception to July 29th, 2023 to identify randomized controlled trails or cohort studies that compared iNPH shunting with placebo or the other treatment. We conducted fixed-effects frequentist meta-analysis to summarize the evidence if the I2<50%, otherwise we used randomized-effects to summarize the evidence. According to different study designs and surgical procedures, we conducted subgroup analysis to explore the heterogeneity source.
Results: A total of 11 studies including 1417 participants were initially identified in this study. All included RCTs were evaluated had a high risk of bias and the cohort studies were evaluated had a low risk of bias. Ventriculoperitoneal(VP) was beneficial to decrease the times of 10m walks (MD=-2.52, 95%CI: -4.78 to -0.26, I2=0). Lumboperitioneal(LP) was beneficial to decrease the cognitive level (MD=1.29, 95%CI: 1.09 to 1.49,I2=0) ,10m walks (MD=-32.20, 95%CI: -48.07 to -16.33) and bladder continuous (MD=-0.25, 95%CI: -0.35 to -0.15,I2=76). On the aspect of adverse events, VP and LP had no difference on subdural hematoma, intracranial infection, intracranial hemorrhage , tube-related complications and seizures. Compared to VP, ventriculoatrial(VA) had higher risk of Subdural hematoma.
Conclusions: VP and LP are testified the best medical treatment for iNPH patients.VA and third ventriculostomy are not considered the best medical treatment for patients up to now."
Objectives: This study aims to determine the effectiveness and safety of iNPH shunting.
Method: In this system review, we systematically searched PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science that compared iNPH shunting from inception to July 29th, 2023 to identify randomized controlled trails or cohort studies that compared iNPH shunting with placebo or the other treatment. We conducted fixed-effects frequentist meta-analysis to summarize the evidence if the I2<50%, otherwise we used randomized-effects to summarize the evidence. According to different study designs and surgical procedures, we conducted subgroup analysis to explore the heterogeneity source.
Results: A total of 11 studies including 1417 participants were initially identified in this study. All included RCTs were evaluated had a high risk of bias and the cohort studies were evaluated had a low risk of bias. Ventriculoperitoneal(VP) was beneficial to decrease the times of 10m walks (MD=-2.52, 95%CI: -4.78 to -0.26, I2=0). Lumboperitioneal(LP) was beneficial to decrease the cognitive level (MD=1.29, 95%CI: 1.09 to 1.49,I2=0) ,10m walks (MD=-32.20, 95%CI: -48.07 to -16.33) and bladder continuous (MD=-0.25, 95%CI: -0.35 to -0.15,I2=76). On the aspect of adverse events, VP and LP had no difference on subdural hematoma, intracranial infection, intracranial hemorrhage , tube-related complications and seizures. Compared to VP, ventriculoatrial(VA) had higher risk of Subdural hematoma.
Conclusions: VP and LP are testified the best medical treatment for iNPH patients.VA and third ventriculostomy are not considered the best medical treatment for patients up to now."