Negative predictors of shunt surgery outcome in normal pressure hydrocephalus

Bådagård, Henrik; Braun, Madelene; Nilsson, Daniel; Stridh, Lars; Virhammar, Johan

doi:10.1111/ane.13200

Cited by 32 publications

(35 citation statements)

References 20 publications

(52 reference statements)

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“…The iNPH patients derived from Uppsala University hospital, where 332 patients with suspected iNPH received shunts during 2011-2015, previously described [17].…”

Section: Methodsmentioning

confidence: 99%

“…However, the observation in the present study that the iNPH Radscale discriminates between definite iNPH and asymptomatic individuals does not tell whether the scale can be used to predict the outcome of surgery as well. The indication for surgery must be evaluated separately, taking age, comorbidity and other prognostic factors into consideration [17,25]. The iNPH Radscale can be used on CT or MR scans when iNPH is suspected by the clinicians, or in en passant finding of ventriculomegaly for example in CT scans after fall accidents.…”

Section: Plos Onementioning

confidence: 99%

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Diagnostic accuracy of the iNPH Radscale in idiopathic normal pressure hydrocephalus

et al. 2020

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Background and purpose The idiopathic normal pressure hydrocephalus (iNPH) Radscale was developed to standardize the evaluation of radiological signs in iNPH. The purpose of this study was to estimate the diagnostic accuracy of the iNPH Radscale in a sample of "true positive" and "true negative" cases. Methods Seventy-five patients with definite iNPH, i.e. who had improved at clinical follow-up one year after ventriculoperitoneal shunt surgery, were compared with 55 asymptomatic individuals from the general population. A radiologist assessed the seven radiological features of the iNPH Radscale in computed tomography of the brain in the patients (preoperatively) and controls. Results The iNPH Radscale score was significantly higher in the iNPH group (Median = 10, interquartile range 9-11) than in the control group (Median = 1, interquartile range 1-2) (p <0.001). Receiver operated characteristics analysis yielded an area under the curve of 99.7%, and an iNPH Radscale score � 4 identified those without iNPH, with a sensitivity of 100%, specificity of 96% and overall accuracy of 98.5%. Conclusions In this study, iNPH Radscale could accurately discriminate between patients with definite iNPH and asymptomatic individuals over 65 years old. According to the results, a diagnosis of iNPH is very likely in patients with an iNPH Radscale score above 8 and corresponding clinical symptoms. On the other hand, the diagnosis should be questioned when the iNPH Radscale score is below the cutoff level of 4. We conclude that the iNPH Radscale could

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“…The iNPH patients derived from Uppsala University hospital, where 332 patients with suspected iNPH received shunts during 2011-2015, previously described [17].…”

Section: Methodsmentioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Diagnostic accuracy of the iNPH Radscale in idiopathic normal pressure hydrocephalus

et al. 2020

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“…The sensitivity of 52.2% for the gait domain means that the prediction of a postoperative positive outcome is slightly better than pure chance. Increased age has been reported as a negative factor for shunt surgery outcome (31,37) but it has also been reported that the age alone should not exclude patients from surgery (38,39). A careful evaluation of patients over 80 years of age is important and the low accuracy of CSF TT for these patients has to be taken into consideration when deciding to offer a shunt operation.…”

Section: Discussionmentioning

confidence: 99%

“…The gait and balance domains are evaluated before and after the CFS TT. The Hellström iNPH scale is a standardized method that has rarely been used as an outcome measure in the evaluation of the CSF TT (23,31).…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Cerebrospinal Fluid Tap Test With the Hellström iNPH Scale for Patients With Idiopathic Normal Pressure Hydrocephalus – a Retrospective Cohort Study of 132 Patients

Rydja¹,

Eleftheriou²,

Lundin³

2020

Preprint

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Background The cerebrospinal fluid tap test (CSF TT) is used for selecting shunt surgery candidates in idiopathic normal pressure hydrocephalus (iNPH). Variations in performance, and different outcome measures and cut-off levels in previous research on the CSF TT make comparison of accuracy difficult between studies. We aimed to evaluate the CSF TT, by using the Hellström iNPH scale for shunted iNPH patients with a standardized method. Methods One hundred thirty-two shunt operated iNPH patients were retrospectively included in this study. The gait and balance domains in the iNPH scale were used as outcome measures for the CSF TT and the total iNPH scale score as postoperatively outcome. To identify responders a cut-off level ≥ 5 points was used. Differences between responders and non-responders to the CSF TT, as well as the sensitivity, speciﬁcity, positive and negative predictive values, accuracy and correlations between outcomes of the CSF TT and postoperatively were calculated. Results In the gait domain, there were 62.9% responders and correspondingly 42.7 % in the balance domain of the CSF TT. CSF TT responders had significantly better outcomes in both the gait and balance domains but not in the neuropsychology or continence domains postoperatively. The sensitivity and specificity of the CSF TT and the outcome of the total iNPH scale score postoperatively were 67.6% and 53.3% for gait and 47.5% and 73.3% for balance. For age ≥ 80 years, the sensitivity and specificity for gait were 52.2% and 60.0%, and for age ≤ 80 years 72.2% and 50.0%. Gait as an outcome measure for both the CSF TT and postoperatively had the highest sensitivity, (73.2%) and specificity (65.7%) for all ages. Conclusions The CSF TT, with Hellström´s iNPH scale as the outcome measure, has clear limitations in predicting postoperative results. The gait domain may be used to detect changes of outcomes in gait, but the balance domain is too insensitive to use as an assessment for the CSF TT. The value of the CFS TT for patients over 80 years of age appears to be even lower. Differential diagnostic considerations together with radiological assessments remain cornerstones in selecting eligible shunt responders.

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“…As such, differential effects on each component of the iNPH clinical triad could not be assessed. Similarly, in such small cohorts, it was not possible to control for other factors associated with shunt responsiveness, such as age [11,55], duration of symptoms [11,[56][57][58], gait disturbance predominance over cognitive impairment [10,11,57,58], the presence of co-morbidities [55,59], and the structural imaging features of iNPH and AD.…”

Section: Weaknesses Of Included Studiesmentioning

confidence: 99%

The role of amyloid PET in patient selection for extra-ventricular shunt insertion for the treatment of idiopathic normal pressure hydrocephalus: A pooled analysis

Mallon

Malhotra

Naik

et al. 2021

Journal of Clinical Neuroscience

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Idiopathic Normal Pressure Hydrocephalus (iNPH) can be effectively treated through shunt insertion. However, most shunted patients experience little or no clinical bene t, which suggests suboptimal patient selection. While contentious, multiple studies have reported poorer shunt outcomes associated with concomitant Alzheimer's disease. Prompted by this observation, multiple studies have assessed the role of amyloid PET, a speci c test for Alzheimer's disease, in patient selection for shunting.Across three relevant studies, a total of 38 patients with suspected iNPH underwent amyloid PET imaging and shunt insertion. Twenty-one patients had a positive clinical response to shunting. 18/28 (64.3%) of patients with a negative amyloid PET and 5/10 (50%) with a positive amyloid PET had a positive response to shunting. The pooled sensitivity, speci city and accuracy was 33.3%, 76.2% and 58.3%. None of these statistics reached statistical signi cance.The results of this pooled analysis do not support the selection of patients with suspected iNPH for shunting on the basis of amyloid PET alone. However, due to small cohort sizes and weakness in study design, further high-quality studies are required to properly determine the role of amyloid PET in assessing this complex patient group.

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Negative predictors of shunt surgery outcome in normal pressure hydrocephalus

Cited by 32 publications

References 20 publications

Diagnostic accuracy of the iNPH Radscale in idiopathic normal pressure hydrocephalus

Diagnostic accuracy of the iNPH Radscale in idiopathic normal pressure hydrocephalus

Evaluating the Cerebrospinal Fluid Tap Test With the Hellström iNPH Scale for Patients With Idiopathic Normal Pressure Hydrocephalus – a Retrospective Cohort Study of 132 Patients

The role of amyloid PET in patient selection for extra-ventricular shunt insertion for the treatment of idiopathic normal pressure hydrocephalus: A pooled analysis

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