SynthesisActa neurochirurgica2023
Radiological predictors of shunt response in the diagnosis and treatment of idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis.
Synthesis in Acta neurochirurgica, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06857136 (The Role of the Glymphatic System Avaluated Thourgh mr Imaging in the Diagnosis and Management of NPH), which is not on this map. Cited by 31 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Role of the Glymphatic System Avaluated Thourgh mr Imaging in the Diagnosis and Management of NPH
Who cites it
31 citing papers in PubMed, 1 synthesis or guideline pooled it, 44 citations in OpenAlex.
- Predictors of Satisfactory Surgical Outcome in Idiopathic Normal Pressure Hydrocephalus (Review).Sovremennye tekhnologii v meditsine · 2024Pooled it
- Radiological DESH score cannot predict outcome after shunt surgery: A Swedish prospective follow-up study.The neuroradiology journal · 2026Article
- Perioperative real-life mobility assessment using wearable step counts in idiopathic normal pressure hydrocephalus after ventriculoperitoneal shunt surgery: a prospective pilot study.Neurosurgical review · 2026Article
- Moving on in hydrocephalus imaging: from 2D to 3D biomarkers.Acta neurochirurgica · 2026Review
- Slow unsteady gait in a population-based cohort: links to ventriculomegaly and INPH-related imaging markers.Fluids and barriers of the CNS · 2026Article
- Clinical Subgroups and Treatment Outcomes in Idiopathic Normal Pressure Hydrocephalus: Application of Machine Learning-Based Clustering.Neurosurgery practice · 2026Article
- MRI-based cerebrospinal fluid volumetric indices for predicting tap test response in idiopathic normal pressure hydrocephalus.Radiological physics and technology · 2026Observational
- Brain ventricle morphology markers in predicting shunt surgery outcome in idiopathic normal-pressure hydrocephalus.Fluids and barriers of the CNS · 2026Article
- Ventricular Anatomy Across CT and MRI in Hydrocephalus: A Retrospective Study.Diagnostics (Basel, Switzerland) · 2026Article
- Analysis of radiological markers in normal pressure hydrocephalus and their association with postoperative outcomes following shunt procedures.Neurosurgical review · 2026Article
- Article
- Assessing CT-based volumetric analysis via deep learning for idiopathic normal pressure hydrocephalus.Brain communications · 2026Article
- Speed of clinical response to external lumbar drainage as a predictor of outcome of ventriculoperitoneal shunt in normal pressure hydrocephalus: A prospective cohort study.Surgical neurology international · 2026Article
- PUMP study: reservoir pumping in suspected underdrained shunted patients with normal pressure hydrocephalus - a prospective single-center study.Acta neurochirurgica · 2025Article
- The Glymphatic-Venous Axis in Brain Clearance Failure: Aquaporin-4 Dysfunction, Biomarker Imaging, and Precision Therapeutic Frontiers.International journal of molecular sciences · 2025Review
- Predictors of shunt response in iNPH: differentiating responders, early and late non-responders, and the role of valve adjustments.Acta neurochirurgica · 2025Article
- Article
- qDESH: a method to quantify disproportionately enlarged subarachnoid space hydrocephalus.Fluids and barriers of the CNS · 2025Article
- Individual-level cortical morphological network analysis in idiopathic normal pressure hydrocephalus: diagnostic and prognostic insights.Fluids and barriers of the CNS · 2025Article
- The contribution of cerebral small vessel disease in idiopathic normal pressure hydrocephalus: Insights from a prospective cohort study.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2025Article
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPatients with the dementia subtype idiopathic normal pressure hydrocephalus (iNPH) may improve clinically following cerebrospinal fluid (CSF) diversion (shunt) surgery, though the predictors of shunt response remain debated. Currently, radiological features play an important role in the diagnosis of iNPH, but it is not well established which radiological markers most precisely predict shunt responsive iNPH.
objectiveTo conduct a systematic review and meta-analysis to identify radiological predictors of shunt responsiveness, evaluate their diagnostic effectiveness, and recommend the most predictive radiological features.
methodsEmbase, MEDLINE, Scopus, PubMed, Google Scholar, and JSTOR were searched for original studies investigating radiological predictors of shunt response in iNPH patients. Included studies were assessed using the ROBINS-1 tool, and eligible studies were evaluated using a univariate meta-analysis.
resultsOverall, 301 full-text papers were screened, of which 28 studies were included, and 26 different radiological features were identified, 5 of these met the inclusion criteria for the meta-analysis: disproportionately enlarged subarachnoid space (DESH), callosal angle, periventricular white matter changes, cerebral blood flow (CBF), and computerized tomography cisternography. The meta-analysis showed that only callosal angle and periventricular white matter changes significantly differentiated iNPH shunt responders from non-responders, though both markers had a low diagnostic odds ratio (DOR) of 1.88 and 1.01 respectively. None of the other radiological markers differentiated shunt responsive from shunt non-responsive iNPH.
conclusionCallosal angle and periventricular changes are the only diagnostically effective radiological predictors of shunt responsive iNPH patients. However, due to the DORs approximating 1, they are insufficient as sole predictors and are advised to be used only in combination with other diagnostic tests of shunt response. Future research must evaluate the combined use of multiple radiological predictors, as it may yield beneficial additive effects that may allow for more robust radiological shunt response prediction.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.