Homburg [Neurosurgery Wiki]

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====== Homburg ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1j7KIQXkY7KEdv-bky56acLR6aR9uk4dawtWaaWcn34oOSRsP-/?limit=15&utm_campaign=pubmed-2&fc=20250606002944}}


Neurochirurgische Klinik
Universitätsklinikum des Saarlandes
Kirrberger Straße
66421 Homburg/Saar
www.uniklinikum-saarland.de
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 	Prof. Dr. med. 
Joachim OERTEL
Direktor
Tel.: 06841/16-24400
Fax: 06841/16-24480
joachim.oertel@uks.eu
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Hannah Spielmann
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Magomed Lepshokov
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Anna Prajsnar-Borak 
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Joachim Oertel
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In a Prospective observational cohort study Spielmann et al. investigates the association between cerebrospinal fluid (CSF) biomarkers (Tau, Phospho-tau, Aβ42/Aβ40 ratio) and neurocognitive outcomes following ventriculoperitoneal (VP) shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH). 80 patients were assessed with neuropsychological tests before and after lumbar puncture, and at 6 weeks and 3 months postoperatively.

===== Strengths =====
  * **Prospective design** with repeated neurocognitive assessments.
  * **Relevant biomarker panel** ([[Tau]], [[P-Tau]], [[Aβ42]]/[[Aβ40]]) with potential prognostic value.
  * Use of **sensitive cognitive tests** beyond [[MMSE]] (e.g., DemTect, TMT A & B).
  * Suggests **personalized treatment strategies** based on CSF biomarker profiles.

===== Weaknesses =====
  * No control group or randomization → **limits causal inference**.
  * **Short follow-up** (3 months); long-term cognitive evolution not assessed.
  * **Confounding factors** (age, comorbidities, baseline cognitive function) not clearly controlled.
  * **No multivariate analysis** or statistical power calculations provided.
  * MMSE used despite **low sensitivity** in detecting iNPH-related changes.
  * **Biomarker thresholds** not standardized or validated.
  * Functional and quality-of-life outcomes not reported.

===== Interpretation =====
  * The **beta-amyloid ratio (Aβ42/Aβ40)** is associated with better cognitive outcomes after shunt surgery.
  * **No significant improvement** observed in MMSE, but specific domains (executive function, psychomotor speed) showed gains.
  * Suggests **Aβ42/Aβ40** as a possible **biomarker for patient selection**, but external validation is needed.

===== Conclusion =====
This study adds to growing evidence that CSF biomarkers, particularly the Aβ42/Aβ40 ratio, may help predict neurocognitive recovery after shunting in iNPH. However, **methodological limitations** reduce the strength of the conclusions. Larger, multicenter trials with **longitudinal follow-up** and **controlled design** are required to confirm its clinical utility.

===== Appraisal Summary =====
^ Category                  ^ Assessment                                                                 ^
| Study Design              | ✅ Prospective, but lacks control group or randomization                    |
| Sample Size               | ⚠️ Modest (n=80), single-region cohort                                     |
| Biomarker Relevance       | ✅ Strong focus on emerging prognostic markers                             |
| Cognitive Testing Battery | ✅ DemTect and TMT used appropriately; MMSE underperforms                   |
| Statistical Analysis      | ⚠️ Not robust; lacks multivariate models or biomarker threshold definition |
| Clinical Utility          | ⚠️ Promising but not yet implementable                                     |
| Innovation                | ✅ High—biomarker-guided prognosis in iNPH                                 |
((Spielmann H, Lepshokov M, Prajsnar-Borak A, Wagenpfeil G, Oertel J. Neurocognitive effects of CSF biomarkers in idiopathic normal pressure hydrocephalus patients undergoing VP shunt placement. Neurosurg Rev. 2025 Jun 5;48(1):484. doi: 10.1007/s10143-025-03609-8. PMID: 40471348.)).