How did the recent article by Satti et al1 pass muster? A review of the status of venous sinus stent placement in 20132 included more patients with stents than the so-called meta-analysis review in your October 2015 issue. Seven of the studies cited in the 2013 analysis had only 1 patient each and were not included in the 2015 analysis; stripped of those 7 single patient studies, the 2015 meta-analysis looks much like the 2013 review. Nevertheless, why choose to include in the meta-analysis a study with only 4 patients—or the studies with only 10, 12, 15, or 18 patients? The power in both the 2013 review and the current meta-analysis lies in the 52-patient study by Ahmed et al,3 in which CSF opening pressure, an essential criterion for the diagnosis of idiopathic intracranial hypertension (IIH), was not documented in either 11 or 9 patients depending on which meta-analysis one chooses to read. Likewise, the 2 studies with 15 patients each (Fields et al4 and Albuquerque et al5) did not record the CSF opening pressure for any of their included patients; and both the 4-patient study (Owler et al6) and the 18-patient study (Kumpe et al7) did not record CSF opening pressure in 1 and 4 patients, respectively. A study of 10 patients noted to be without recorded CSF opening pressures in the 2013 analysis (Bussière et al8) is noted in Table 4 of the 2015 meta-analysis as having an opening pressure range of 25–50 cm H20. What was the source of that post hoc information?
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