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Table 6 The use of Sylvian fissure size for prediction of shunt response in iNPH

From: Radiological predictors of shunt response in the diagnosis and treatment of idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis

Study

Sample size

Radiological methodology

Cutoff specification

Image specification

Image plane

Main reported outcomes

Poca et al., 2004 [45]

n = 43

•Sylvian fissures were categorized into normal, obliterated or dilated

•N/A

•CT

•N/A

•13 patients had normal fissures, 29 had dilated fissures while 1 was obliterated. Patients with normal fissures showed greater improvement in Trail Making Test B (chi-square test: 7.18, p = 0.007)

Agerskov et al., 2019 [2]

n = 168

•Graded from 0–2

•N/A

•MRI 1.5 T. trans-axial T1-weighted images

•Axial slice

•28% of patients had grade 0, 45% grade 1 and 27% grade 2

•There was no difference, in each grade, between SR and SNR

Narita et al., 2016 [41]

n = 103

•Graded on visual ordinal scale from 0–3: 0 – narrowed, 1- normal; 2—mildly dilated, and 3—severely dilated

•N/A

•3D T1-weighted MRI obtained with a Signa 1.5 T MR imaging unit

•Transverse and axial

•Simple linear regression analysis: There was an association between Sylvian fissure dilation and change in iNPHGS gait (B = 0.59, R2 = 0.08, p = .029). There was no association with total score, cognitive or urinary subjection, or TUG or MMSE. (1.03, − 0.09, 0.53, − 2.65, 1.00 respectively)

Virhammar et al., 2014 [60]

n = 108

•Ordinal scale: Graded 0–3 evaluated at level of central part of brain stem, angulated along brain stem

•Height: Mean (mm) measurement at 5 different locations perpendicular to fissure direction in midpoint between skull and insular cortex

•N/A

•T2 Flair, T1-weighted MRI. (9% of patients on 3 T scanner; 70% on a 1.5 T scanner, 14% on a 1 T scanner and 7% on a 0.5 T scanner

•Ordinal: Coronal

•Height: Sagittal

•Ordinal: OR between SR and SNR [ 1.35 (0.57–3.21), p = 0.5] was not significant

•Height: OR between SR and SNR [1.20 (0.59–2.43), p = 0.62] was not significant

  1. Studies included assessing the use of any advanced imaging radiological marker as predictor of shunt responsiveness. SR, shunt response; S-NR, shunt non-response; MMSE, mini mental state examination; TUG, timed up and go test; iNPHGS, idiopathic normal-pressure hydrocephalus grading scale