Accuracy of CSF tap test and lumbar infusion test in predicting shunt response in idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis.
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引用次数: 0
Abstract
Background: Idiopathic normal pressure hydrocephalus (iNPH) presents with gait disturbance, cognitive impairment, and urinary incontinence. The cerebrospinal fluid tap test (CSF-TT) and lumbar infusion test (LIT) are commonly used to predict postoperative improvement after shunt surgery; however, their validity remains debated.
Methods: We performed a systematic review and meta-analysis to assess the sensitivity and specificity of CSF-TT and LIT. The protocol was registered in PROSPERO (CRD42023454502). Reporting followed the PRISMA-DTA guidelines, and the certainty of evidence was assessed using the GRADE approach.
Results: Of 1,955 studies, 15 were included, reporting on 721 CSF-TT and 393 LIT patients, with shunt surgery as the reference standard. Nine CSF-TT studies (n = 700) and five LIT studies (n = 368) contributed to the primary meta-analysis. Considerable heterogeneity existed in test protocols, timing of assessment, and outcome measures. Several studies were retrospective with a high risk of bias. The pooled estimates were derived from a limited number of heterogeneous studies. Using a bivariate random-effects model, pooled sensitivity and specificity of CSF-TT were 64.1% (95% CI 49.2-76.6%, I2 81.3%) and 54.8% (95% CI 41.8-67.2%, I2 59.7%), respectively. The certainty of evidence was very low for sensitivity due to bias, inconsistency, and imprecision, and low for poor specificity due to bias and inconsistency. LIT showed a pooled sensitivity of 77.5% (95% CI 70.2-83.4%, I2 14.7%) and a specificity of 28.3% (95% CI 19.0-39.9%, I2 4.6%), with moderate certainty for sensitivity and moderate certainty for poor specificity.
Conclusion: Both CSF-TT and LIT show poor specificity for predicting shunt responsiveness in iNPH, with low-certainty evidence for CSF-TT and moderate-certainty evidence for LIT. A positive result from either test should not be used in isolation to guide surgical decisions. Standardized prospective studies with clearly defined patient selection criteria and outcome measures are needed to establish the true diagnostic value of these tests.
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