Predictors of outcome following cerebral aqueductoplasty: An individual participant data meta-analysis

Aria Fallah, Anthony C. Wang, Alexander G. Weil, George M. Ibrahim, Alireza Mansouri, Sanjiv Bhatia

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

BACKGROUND: The evidence supporting the efficacy and safety of cerebral aqueductoplasty (CA) is limited to small surgical series. OBJECTIVE: To perform an individual participant data meta-analysis to determine the efficacy and safety of CA and to determine the effect of patient's age, etiology, surgical approach, and use of stent on success. METHODS: Electronic databases (MEDLINE, EMBASE, and CINAHL) were searched with no language or date restrictions to identify cohort studies of consecutive participants undergoing CA (without concomitant endoscopic third ventriculostomy or cerebrospinal fluid [CSF] shunt) that reported outcome. Outcome was defined as the time elapsed from the index operation until a second procedure was performed for CSF diversion. RESULTS: Of 146 citations, 14 articles reporting on 137 participants were eligible. One hundred three participants (75%) did not require a second CSF diversion procedure. The mean duration until repeat CSF diversion procedure was 121.6 months (95% confidence interval [CI], 102.2-141.0). In multivariate analysis, older age at surgery (hazard ratio [HR], 0.43; 95% CI, 0.21-0.88; P = .020), congenital etiology (HR, 0.18; 95% CI, 0.04-0.85; P = .030), and use of stent (HR, 0.30; 95% CI, 0.13-0.70; P = .006) were independent predictors of good outcome. Morbidity, mainly ophthalmoparesis and hemorrhage, was experienced in 22% of participants. CONCLUSION: Small retrospective cohort studies are inherently prone to biases, some of which are overcome through the use of individual participant data. The best available evidence suggests that CA is an effective procedure with a moderate morbidity profile. Older age at surgery, congenital etiology, and use of stent predict a good outcome with respect to delaying the requirement for a second CSF diversion procedure.

Original languageEnglish (US)
Pages (from-to)285-296
Number of pages12
JournalNeurosurgery
Volume78
Issue number2
DOIs
StatePublished - Feb 1 2016

Fingerprint

Meta-Analysis
Cerebrospinal Fluid
Confidence Intervals
Stents
Cohort Studies
Cerebrospinal Fluid Shunts
Ventriculostomy
Morbidity
Safety
Ophthalmoplegia
MEDLINE
Language
Multivariate Analysis
Retrospective Studies
Databases
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Fallah, Aria ; Wang, Anthony C. ; Weil, Alexander G. ; Ibrahim, George M. ; Mansouri, Alireza ; Bhatia, Sanjiv. / Predictors of outcome following cerebral aqueductoplasty : An individual participant data meta-analysis. In: Neurosurgery. 2016 ; Vol. 78, No. 2. pp. 285-296.
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title = "Predictors of outcome following cerebral aqueductoplasty: An individual participant data meta-analysis",
abstract = "BACKGROUND: The evidence supporting the efficacy and safety of cerebral aqueductoplasty (CA) is limited to small surgical series. OBJECTIVE: To perform an individual participant data meta-analysis to determine the efficacy and safety of CA and to determine the effect of patient's age, etiology, surgical approach, and use of stent on success. METHODS: Electronic databases (MEDLINE, EMBASE, and CINAHL) were searched with no language or date restrictions to identify cohort studies of consecutive participants undergoing CA (without concomitant endoscopic third ventriculostomy or cerebrospinal fluid [CSF] shunt) that reported outcome. Outcome was defined as the time elapsed from the index operation until a second procedure was performed for CSF diversion. RESULTS: Of 146 citations, 14 articles reporting on 137 participants were eligible. One hundred three participants (75{\%}) did not require a second CSF diversion procedure. The mean duration until repeat CSF diversion procedure was 121.6 months (95{\%} confidence interval [CI], 102.2-141.0). In multivariate analysis, older age at surgery (hazard ratio [HR], 0.43; 95{\%} CI, 0.21-0.88; P = .020), congenital etiology (HR, 0.18; 95{\%} CI, 0.04-0.85; P = .030), and use of stent (HR, 0.30; 95{\%} CI, 0.13-0.70; P = .006) were independent predictors of good outcome. Morbidity, mainly ophthalmoparesis and hemorrhage, was experienced in 22{\%} of participants. CONCLUSION: Small retrospective cohort studies are inherently prone to biases, some of which are overcome through the use of individual participant data. The best available evidence suggests that CA is an effective procedure with a moderate morbidity profile. Older age at surgery, congenital etiology, and use of stent predict a good outcome with respect to delaying the requirement for a second CSF diversion procedure.",
author = "Aria Fallah and Wang, {Anthony C.} and Weil, {Alexander G.} and Ibrahim, {George M.} and Alireza Mansouri and Sanjiv Bhatia",
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Predictors of outcome following cerebral aqueductoplasty : An individual participant data meta-analysis. / Fallah, Aria; Wang, Anthony C.; Weil, Alexander G.; Ibrahim, George M.; Mansouri, Alireza; Bhatia, Sanjiv.

In: Neurosurgery, Vol. 78, No. 2, 01.02.2016, p. 285-296.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Predictors of outcome following cerebral aqueductoplasty

T2 - An individual participant data meta-analysis

AU - Fallah, Aria

AU - Wang, Anthony C.

AU - Weil, Alexander G.

AU - Ibrahim, George M.

AU - Mansouri, Alireza

AU - Bhatia, Sanjiv

PY - 2016/2/1

Y1 - 2016/2/1

N2 - BACKGROUND: The evidence supporting the efficacy and safety of cerebral aqueductoplasty (CA) is limited to small surgical series. OBJECTIVE: To perform an individual participant data meta-analysis to determine the efficacy and safety of CA and to determine the effect of patient's age, etiology, surgical approach, and use of stent on success. METHODS: Electronic databases (MEDLINE, EMBASE, and CINAHL) were searched with no language or date restrictions to identify cohort studies of consecutive participants undergoing CA (without concomitant endoscopic third ventriculostomy or cerebrospinal fluid [CSF] shunt) that reported outcome. Outcome was defined as the time elapsed from the index operation until a second procedure was performed for CSF diversion. RESULTS: Of 146 citations, 14 articles reporting on 137 participants were eligible. One hundred three participants (75%) did not require a second CSF diversion procedure. The mean duration until repeat CSF diversion procedure was 121.6 months (95% confidence interval [CI], 102.2-141.0). In multivariate analysis, older age at surgery (hazard ratio [HR], 0.43; 95% CI, 0.21-0.88; P = .020), congenital etiology (HR, 0.18; 95% CI, 0.04-0.85; P = .030), and use of stent (HR, 0.30; 95% CI, 0.13-0.70; P = .006) were independent predictors of good outcome. Morbidity, mainly ophthalmoparesis and hemorrhage, was experienced in 22% of participants. CONCLUSION: Small retrospective cohort studies are inherently prone to biases, some of which are overcome through the use of individual participant data. The best available evidence suggests that CA is an effective procedure with a moderate morbidity profile. Older age at surgery, congenital etiology, and use of stent predict a good outcome with respect to delaying the requirement for a second CSF diversion procedure.

AB - BACKGROUND: The evidence supporting the efficacy and safety of cerebral aqueductoplasty (CA) is limited to small surgical series. OBJECTIVE: To perform an individual participant data meta-analysis to determine the efficacy and safety of CA and to determine the effect of patient's age, etiology, surgical approach, and use of stent on success. METHODS: Electronic databases (MEDLINE, EMBASE, and CINAHL) were searched with no language or date restrictions to identify cohort studies of consecutive participants undergoing CA (without concomitant endoscopic third ventriculostomy or cerebrospinal fluid [CSF] shunt) that reported outcome. Outcome was defined as the time elapsed from the index operation until a second procedure was performed for CSF diversion. RESULTS: Of 146 citations, 14 articles reporting on 137 participants were eligible. One hundred three participants (75%) did not require a second CSF diversion procedure. The mean duration until repeat CSF diversion procedure was 121.6 months (95% confidence interval [CI], 102.2-141.0). In multivariate analysis, older age at surgery (hazard ratio [HR], 0.43; 95% CI, 0.21-0.88; P = .020), congenital etiology (HR, 0.18; 95% CI, 0.04-0.85; P = .030), and use of stent (HR, 0.30; 95% CI, 0.13-0.70; P = .006) were independent predictors of good outcome. Morbidity, mainly ophthalmoparesis and hemorrhage, was experienced in 22% of participants. CONCLUSION: Small retrospective cohort studies are inherently prone to biases, some of which are overcome through the use of individual participant data. The best available evidence suggests that CA is an effective procedure with a moderate morbidity profile. Older age at surgery, congenital etiology, and use of stent predict a good outcome with respect to delaying the requirement for a second CSF diversion procedure.

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U2 - 10.1227/NEU.0000000000001024

DO - 10.1227/NEU.0000000000001024

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