Torregrossa Fabio, Buscemi Felice, Gulino Vincenzo, Campisi Benedetta Maria, Teresi Gaia, Grasso Giovanni
Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy.
Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy.
World Neurosurg. 2023 Nov;179:197-203.e1. doi: 10.1016/j.wneu.2023.08.105. Epub 2023 Aug 30.
Although shunting has been shown to ameliorate symptoms in idiopathic normal pressure hydrocephalus (iNPH), its impact on health-related quality of life (HRQoL) has yet to be fully elucidated. Patient and caregiver subjective life satisfaction and HRQoL represent crucial indicators for assessing the well-being of individuals facing chronic illnesses, including iNPH. This study aimed to systematically analyze the existing data about HRQoL in iNPH-treated patients to evaluate the role of surgical treatment in such a scenario.
Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the literature in the PubMed/Medline, Web of Science, and Scopus databases was searched. Fourteen studies met our inclusion criteria. The Joanna Briggs Institute critical appraisal tool was used to assess the risk of bias.
Overall, HRQoL improved significantly within 1 year after shunt placement although patients with iNPH reported worse HRQoL values compared with healthy-matched individuals. Up to 5 years after shunting, a sustained heterogeneity exists on published data showing improved scores across all domains for at least 21 months after shunting. Further, although surgical treatment can improve HRQoL, long-term follow-up showed that it remained lower than that of healthy controls. These data suggest a significant decrease of HRQoL in patients with iNPH over time after shunting, probably due to aging, comorbidities, and disease progression.
Despite that iNPH has been recognized as a potentially reversible neurological disorder, the available data about the impact of shunting on the HRQoL are unsatisfactory. To improve the well-informed clinical decision-making, it is essential to reach additional high-quality evidence regarding the effect of shunting on HRQoL. New prospective studies, using validated instruments specifically tailored for assessing HRQoL in patients with iNPH, and improved reporting standards are needed. Current evidence suggests that although shunting can provide initial benefits, affected patients may experience long-term impairment in HRQoL.
尽管分流术已被证明可改善特发性正常压力脑积水（iNPH）的症状，但其对健康相关生活质量（HRQoL）的影响尚未完全阐明。患者和照料者的主观生活满意度以及HRQoL是评估包括iNPH在内的慢性病患者幸福感的关键指标。本研究旨在系统分析iNPH治疗患者中有关HRQoL的现有数据，以评估手术治疗在这种情况下的作用。
按照系统评价和Meta分析的首选报告项目（PRISMA）指南，检索了PubMed/Medline、科学网和Scopus数据库中的文献。14项研究符合我们的纳入标准。使用乔安娜·布里格斯研究所的批判性评价工具评估偏倚风险。
总体而言，分流术后1年内HRQoL显著改善，尽管iNPH患者报告的HRQoL值比健康对照个体更差。分流术后长达5年，已发表的数据存在持续的异质性，表明分流术后至少21个月所有领域的得分均有所改善。此外，尽管手术治疗可改善HRQoL，但长期随访显示其仍低于健康对照。这些数据表明，分流术后iNPH患者的HRQoL会随着时间的推移而显著下降，可能是由于衰老、合并症和疾病进展所致。
尽管iNPH已被认为是一种潜在可逆的神经系统疾病，但关于分流术对HRQoL影响的现有数据并不令人满意。为了改善临床决策的充分知情性，有必要获得关于分流术对HRQoL影响的更多高质量证据。需要开展新的前瞻性研究，使用专门为评估iNPH患者的HRQoL而定制的经过验证的工具，并提高报告标准。目前的证据表明，尽管分流术可带来初始益处，但受影响的患者可能会在HRQoL方面经历长期损害。
