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Effectiveness and Safety of Ventriculoperitoneal Shunt Versus Lumboperitoneal Shunt for Idiopathic Intracranial Hypertension: A Systematic Review and Comparative Meta-Analysis.
Andreão, Filipi Fim; Ferreira, Marcio Yuri; Oliveira, Leonardo de Barros; Sousa, Marcelo Porto; Palavani, Lucca B; Rairan, Luis García; Tinti, Isadora Santo Urbano; Júnyor, Flavio de Souza; Batista, Sávio; Bertani, Raphael; Amarillo, Diego Gomez; Daccach, Fernando Hakim.
Afiliação
  • Andreão FF; Department of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
  • Ferreira MY; Department of Neurosurgery, Ninth July University, São Paulo, São Paulo, Brazil.
  • Oliveira LB; Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil.
  • Sousa MP; Department of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
  • Palavani LB; Department of Neurosurgery, Max Planck University Center, Indaiatuba, São Paulo, Brazil. Electronic address: lucca.palavani730@al.unieduk.com.br.
  • Rairan LG; Neurosurgery Resident, Universidad Nacional de Colombia, Bogotá, Colombia.
  • Tinti ISU; Department of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
  • Júnyor FS; Department of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
  • Batista S; Department of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
  • Bertani R; Department of Neurosurgery, University of São Paulo, São Paulo, São Paulo, Brazil.
  • Amarillo DG; Department of Neurosurgery, Fundación Santafé de Bogotá, Bogotá, Colombia.
  • Daccach FH; Department of Neurosurgery, Fundación Santafé de Bogotá, Bogotá, Colombia.
World Neurosurg ; 185: 359-369.e2, 2024 05.
Article em En | MEDLINE | ID: mdl-38428810
ABSTRACT

INTRODUCTION:

Idiopathic Intracranial Hypertension (IIH) is a condition characterized by elevated intracranial pressure. Although several mechanisms have been proposed as underlying causes of IIH, no identifiable causative factor has been determined for this condition. Initial treatments focus on weight or CSF reduction, but severe cases may require surgery. This study compares outcomes in IIH patients treated with lumboperitoneal shunts (LPSs) versus ventriculoperitoneal shunts (VPSs).

METHODS:

This systematic-review and meta-analysis follows Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and includes studies about VPS and LPS patients, reporting one of the outcomes of interest. We conducted searches on PubMed, Embase, Web of Science, and Cochrane Library.

RESULTS:

Our analysis involved twelve studies, comprising 5990 patients. The estimated odds ratio (OR) for visual improvement was 0.97 (95% CI 0.26-3.62; I2 = 0%) and for headache improvement was 0.40 (95% CI 0.20-0.81; I2 = 0%), favoring LPS over VPS. Shunt revision analysis revealed an OR of 1.53 (95% CI 0.97-2.41; I2 = 77%). The shunt complications showed an OR of 0.91 (95% CI 0.68-1.22; I2 = 0%). The sub-analyses for shunt failure uncovered an OR of 1.41 (95% CI 0.92-2.18; I2 = 25%) and for shunt infection events an OR of 0.94 (95% CI 0.50-1.75; I2 = 0%).

CONCLUSIONS:

The interventions showed general equivalence in complications, shunt failure, and other outcomes, but LPS seems to hold an advantage in improving headaches. Substantial heterogeneity highlights the need for more conclusive evidence, emphasizing the crucial role for further studies. The findings underscore the importance of considering a tailored decision between VPS and LPS for the management of IIH patients.
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Texto completo: 1 Bases de dados: MEDLINE Assunto principal: Pseudotumor Cerebral / Derivação Ventriculoperitoneal Limite: Humans Idioma: En Revista: World Neurosurg Assunto da revista: NEUROCIRURGIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil

Texto completo: 1 Bases de dados: MEDLINE Assunto principal: Pseudotumor Cerebral / Derivação Ventriculoperitoneal Limite: Humans Idioma: En Revista: World Neurosurg Assunto da revista: NEUROCIRURGIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil