Abstract：
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).
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.
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%).
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.
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.
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%).
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.
摘要：
背景：简介：特发性颅内高血压（IIH）是一种以颅内压升高为特征的疾病。尽管已经提出了几种机制作为IIH的根本原因，对于这种情况，尚未确定可识别的致病因素。初始治疗的重点是减轻体重或减少脑脊液，但是严重的病例可能需要手术。这项研究比较了接受腰腹膜分流术（LPS）和脑室腹膜分流术（VPS）治疗的IIH患者的预后。
方法：本系统综述和荟萃分析遵循PRISMA指南，包括关于VPS和LPS患者的研究，报告感兴趣的结果之一。我们在PubMed上进行了搜索,Embase,WebofScience,科克伦图书馆
结果：我们的分析涉及12项研究，包括5990名患者。视力改善的估计比值比（OR）为0.97（95％CI0.26至3.62；I2=0％），头痛改善为0.40（95％CI0.20至0.81；I2=0％），偏爱LPS而不是VPS。分流修正分析显示OR为1.53（95%CI为0.97至2.41；I2=77%）。分流并发症显示OR为0.91（95％CI为0.68至1.22；I2=0％）。分流失败的子分析发现OR为1.41（95％CI0.92至2.18；I2=25％），分流感染事件的OR为0.94（95％CI0.50至1.75；I2=0％）。
结论：干预措施在并发症方面表现出大致等效，分流故障,和其他结果，但是LPS似乎在改善头痛方面具有优势。大量的异质性突出了需要更确凿的证据，强调进一步研究的关键作用。研究结果强调了考虑VPS和LPS之间的量身定制决策对于IIH患者管理的重要性。
方法：本系统综述和荟萃分析遵循PRISMA指南，包括关于VPS和LPS患者的研究，报告感兴趣的结果之一。我们在PubMed上进行了搜索,Embase,WebofScience,科克伦图书馆
结果：我们的分析涉及12项研究，包括5990名患者。视力改善的估计比值比（OR）为0.97（95％CI0.26至3.62；I2=0％），头痛改善为0.40（95％CI0.20至0.81；I2=0％），偏爱LPS而不是VPS。分流修正分析显示OR为1.53（95%CI为0.97至2.41；I2=77%）。分流并发症显示OR为0.91（95％CI为0.68至1.22；I2=0％）。分流失败的子分析发现OR为1.41（95％CI0.92至2.18；I2=25％），分流感染事件的OR为0.94（95％CI0.50至1.75；I2=0％）。
结论：干预措施在并发症方面表现出大致等效，分流故障,和其他结果，但是LPS似乎在改善头痛方面具有优势。大量的异质性突出了需要更确凿的证据，强调进一步研究的关键作用。研究结果强调了考虑VPS和LPS之间的量身定制决策对于IIH患者管理的重要性。
