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Predictors of Outcome Following Cerebral Aqueductoplasty: An Individual Participant Data Meta-analysis
Aria Fallah1, Anthony C Wang, Alexander G Weil
1*Department of Neurosurgery, University of California Los Angeles, Los Angeles, California; ‡Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; §Department of Neurosurgery, University of Miami Health System, Miami, Florida; ¶Division of Neurosurgery and ‖Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.
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.
