Predictive Factors Of Gait Improvement After Shunt In Idiopathic Normal Pressure Hydrocephalus:a Meta-Analysis

Objective:To investigate the causes of gait disorder in patients with idiopathic normal pressure hydrocephalus and the main predictors of gait disorder improvement after cerebrospinal fluid shunt.Methods:Relevant human studies carried out in foreign databases Pubmed,GoogleScholar,Web of Science,Embase,Cochrane library and Chinese database were searched,and the prediction of gait disorder improvement in patients with idiopathic normal pressure hydrocephalus after triage was searched,from the publication of relevant literatures to 2019.A meta-analysis of the main results was performed.After the relevant data were extracted by two independent researchers,the RevMan5.3 software was used for Meta analysis of the data extracted by the above two evaluators.The weighted mean difference(WMD)of the 95%confidence interval(CI)was estimated using a random effect or fixed effect model.Results:After screening the literatures related to the study contents,a total of 8 original studies in this study met the inclusion criteria,and the last 8 literatures were included in the meta-analysis,including 223 patients with idiopathic normal pressure hydrocephalus.The main results showed that the preoperative and postoperative gait mean difference(MD)values were significantly different(WMD 1.24;95%CI:1.01 to 1.47,P<0.00001).According to the improvement of postoperative gait disorder,the patients were divided into two groups:the group with obvious improvement and the group with insignificant improvement.In this meta-analysis,we revealed the characteristics of three maj or predictors affecting the improvement of gait disorder after shunt in patients with idiopathic normal pressure hydrocephalus,including preoperative changes in the anatomical structure of the middle brain(wmd-0.19;95%CI:-0.22 to-0.15;P<0.00001),and the patient's age(wmd-2.33).95%CI:-4.18 to-0.47;P=0.01),preoperative corticospinal tract compression(WMD 0.02;95%CI:0.00 to 0.04;P=0.04).Conclusion:Age of patients,preoperative corticospinal tract compression,and preoperative changes in the anatomical structure of the middle brain were the related predictors of the improvement of gait disorder after shunt in patients with idiopathic normal pressure hydrocephalus.