TY - JOUR
T1 - Thresholds of resistance to CSF outflow in predicting shunt responsiveness
AU - Kim, Dong Ju
AU - Kim, Hakseung
AU - Kim, Young Tak
AU - Yoon, Byung C.
AU - Czosnyka, Zofia
AU - Park, Kun Woo
AU - Czosnyka, Marek
PY - 2015/1/1
Y1 - 2015/1/1
N2 - Objectives: Disturbances in cerebrospinal fluid (CSF) absorption capacity represent one of the primary causes of normal pressure hydrocephalus (NPH). The resistance to CSF outflow (Rout) may reflect the severity of this disturbance and has been used as a supplementary parameter to predict shunt responsiveness. However, there is no widely accepted threshold of Rout in this scenario. This study aimed to determine the most appropriate threshold through meta-analyses.Methods: A total of four previously reported cutoff values of Rout (10, 12, 15, and 18 mmHg/ml/minutes) were selected as potential thresholds. A systematic review of existing studies involving NPH, shunt surgeries, and Rout was conducted. The pooled results from retrieved articles were subjected to statistical analyses.Results: A total of nine studies were included in the meta-analyses based on the available preoperative Rout and postoperative improvement of subjects. The odds ratios of the four thresholds were 2.82, 3.58, 2.72, and 2.38 for 10, 12, 15, and 18 mmHg/ml/minutes of Rout, respectively. The Rout of 12 mmHg/ml/ minutes yielded high accuracy (72.95%), high sensitivity (80.26%), and moderate specificity (46.79%).Discussion: The presented study conducted meta-analyses and revealed that a Rout of 12 mmHg/ml/ minutes is the most suitable threshold for predicting shunt responsiveness in NPH patients.
AB - Objectives: Disturbances in cerebrospinal fluid (CSF) absorption capacity represent one of the primary causes of normal pressure hydrocephalus (NPH). The resistance to CSF outflow (Rout) may reflect the severity of this disturbance and has been used as a supplementary parameter to predict shunt responsiveness. However, there is no widely accepted threshold of Rout in this scenario. This study aimed to determine the most appropriate threshold through meta-analyses.Methods: A total of four previously reported cutoff values of Rout (10, 12, 15, and 18 mmHg/ml/minutes) were selected as potential thresholds. A systematic review of existing studies involving NPH, shunt surgeries, and Rout was conducted. The pooled results from retrieved articles were subjected to statistical analyses.Results: A total of nine studies were included in the meta-analyses based on the available preoperative Rout and postoperative improvement of subjects. The odds ratios of the four thresholds were 2.82, 3.58, 2.72, and 2.38 for 10, 12, 15, and 18 mmHg/ml/minutes of Rout, respectively. The Rout of 12 mmHg/ml/ minutes yielded high accuracy (72.95%), high sensitivity (80.26%), and moderate specificity (46.79%).Discussion: The presented study conducted meta-analyses and revealed that a Rout of 12 mmHg/ml/ minutes is the most suitable threshold for predicting shunt responsiveness in NPH patients.
KW - Infusion study
KW - Meta-analysis
KW - Normal pressure hydrocephalus
KW - Resistance to CSF outflow
KW - Shunt responsiveness
UR - http://www.scopus.com/inward/record.url?scp=84921800643&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84921800643&partnerID=8YFLogxK
U2 - 10.1179/1743132814Y.0000000454
DO - 10.1179/1743132814Y.0000000454
M3 - Article
C2 - 25323618
AN - SCOPUS:84921800643
VL - 37
SP - 332
EP - 340
JO - Neurological Research
JF - Neurological Research
SN - 0161-6412
IS - 4
ER -