Comparison of the Benefits of the Lumbar Infusion Test and Lumbar Drainage in the Treatment of Hydrocephalus


Authors: M. Mohapl 1;  P. Vaněk 1;  O. Bradáč 1;  D. Hořínek 1;  K. Saur 1;  M. Mohaplová 2
Authors‘ workplace: Neurochirurgická klinika 1. LF UK a IPVZ, ÚVN Praha 1;  Dětská psychiatrická klinika 2. LF UK a FN v Motole, Praha 2
Published in: Cesk Slov Neurol N 2010; 73/106(6): 685-688
Category: Original Paper

Overview

The authors present the results of a prospective study comparing the benefits of the lumbar infusion test and external lumbar drainage in the diagnosis of normal-pressure hydrocephalus. Over a period of 24 months, 60 patients (age 29–83, average 66.5) were exa­mined. The main symptom was gait impairment (53 patients), while disturbances of memory were noted in 44 subjects and incontinence in 36 individuals. All three were present in 28 subjects. A lumbar infusion test was performed on all patients, with a resistance to outflow >12 ­mmHg/­ml/­min or more considered as the level of cerebrospinal fluid resorption impairment. A lumbar infusion test followed immediately after the lumbar infusion test procedure and the effect of cerebrospinal fluid derivation was evaluated after 120 hours. The lumbar infusion test was positive in 23 subjects and 19 individuals in this group showed significant improvement after external lumbar drainage, while no significant improvement was observed in 4 of them. In the group with negative lumbar infusion test, an improvement was noted in 12 of the 37 subjects. The lumbar infusion test is a simple and effective method of diagnostic evaluation in patients in whom a diagnosis of normal-pressure hydrocephalus is suspected. Due to lower sensitivity, the diagnostic algorithm should also include lumbar drainage test in the event of negative or borderline results.

Key words:
normal pressure hydrocephalus – lumbar infusion test – external lumbar drainage


Sources

1. Adams R, Fisher C, Hakim S, Ojemann R, Sweet W. Symptomatic occult hydrocephalus with “normal” cerebrospinal-fluid pressure.a treatable syndrome. N Engl J Med 1965; 273: 117–126.

2. Hakim S, Adams R. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci 1965; 2(4): 307–327.

3. Kiefer M, Meier U, Eymann R. Does idiopathic normal pressure hydrocephalus always mean a poor prognosis? Acta Neurochir Suppl 2010; 106: ­101–106.

4. Pujari S, Kharkar S, Metellus P, Shuck J, Williams MA, Rigamonti D. Normal pressure hydrocephalus: long-term outcome after shunt surgery. J Neurol Neurosurg Psychiatry 2008; 79(11): 1282–1286.

5. Hebb A, Cusimano M. Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome. Neurosurgery 2001; 49(5): 1166–1184.

6. Greitz D. Radiological assessment of hydrocephalus: new theories and implications for therapy. Neurosurg Rev 2004; 27(3): 145–165.

7. Marmarou A, Bergsneider M, Klinge P, Relkin N, Black P. The value of supplemental prognostic tests for the preoperative assessment of idiopathic normal-pressure hydrocephalus. Neurosurgery 2005; 57 (Suppl 3): S17–S28.

8. Stolze H, Kuhtz-Buschbeck J, Drücke H, Jöhnk K, Diercks C, Palmié S et al. Gait analysis in idiopathic normal pressure hydrocephalus – which parameters respond to the CSF tap test? Clin Neurophysiol 2000; 111(9): 1678–1686.

9. Bech-Azeddine R, Høgh P, Juhler M, Gjerris F, Waldemar G. Idiopathic normal-pressure hydrocephalus: clinical comorbidity correlated with cerebral biopsy findings and outcome of cerebrospinal fluid shunting. J Neurol Neurosurg Psychiatry 2007; 78(2): 157–161.

10. Raftopoulos C, Deleval J, Chaskis C, Leonard A, Cantraine F, Desmyttere F et al. Cognitive recovery in idiopathic normal pressure hydrocephalus: a prospective study. Neurosurgery 1994; 35(3): ­397–404.

11. Aho TR, Karis PJ. Normal pressure hydrocephalus: Diagnostic imaging and prognostic assessment. BNI Quarterly 2003; 19(2): 16–22.

12. Lezak M. Neuropsychological Assessment. 4th ed. New York: Oxford University Press 2003.

13. Boon A, Tans J, Delwel E, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA et al. The Dutch normal-pressure hydrocephalus study. How to select patients for shunting? An analysis of four diagnostic criteria. Surg Neurol 2000; 53(3): 201–207.

14. Boon A, Tans J, Delwel E, Egeler-Peerdeman S, Hanlo P, Wurzer H et al. Dutch Normal-Pressure Hydrocephalus Study: the role of cerebrovascular disease. J Neurosurg 1999; 90(2): 221–226.

15. Boon A, Tans J, Delwel E, Egeler-Peerdeman S, Hanlo P, Wurzer H et al. Dutch normal-pressure hydrocephalus study: prediction of outcome after shunting by resistance to outflow of cerebrospinal fluid. J Neurosurg 1997; 87(5): 687–693.

16. Vaněk P, Sameš M. Normotenzní hydrocefalus – význam lumbálního infuzního testu pro diagnostiku a efekt zkratové operace (analýza souboru pacientů z let 1992–1999). Cesk Slov Neurol N 2002; 65/98(4): 250–256.

17. Savolainen S, Hurskainen H, Paljärvi L, Alafuzoff I, Vapalahti M. Five-year outcome of normal pressure hydrocephalus with or without a shunt: predictive value of the clinical signs, neuropsychological evaluation and infusion test. Acta Neurochir 2002; 144(6): 515–523.

18. Meier U, Lemcke J. Co-morbidity as a predictor of outcome in patients with idiopathic normal-pressure hydrocephalus. Acta Neurochir Suppl 2010; 106: 127–130.

19. Scollato A, Gallina P, Gautam B, Pellicanò G, ­Cavallini C, Tenenbaum R et al. Changes in aqueductal CSF stroke volume in shunted patients with idiopathic normal-pressure hydrocephalus. ANJR Am J Neuroradiol 2009; 30(8): 1580–1586.

20. Ng SE, Low AM, Tang KK, Chan YH, Kwok RK. Value of quantitative MRI biomarkers (Evans’ index, aqueductal flow rate, and apparent diffusion coefficient) in idiopathic normal pressure hydrocephalus. J Magn Reson Imaging 2009; 30(4): 708–715.

21. Williams M, Razumovsky A, Hanley D. Comparison of Pcsf monitoring and controlled CSF drainage diagnose normal pressure hydrocephalus. Acta Neurochir Suppl 1998; 71: 328–330.

22. Takeuchi T, Kasahara E, Iwasaki M, Mima T, Mori K. Indications for shunting in patients with idiopathic normal pressure hydrocephalus presenting with dementia and brain atrophy (atypical idiopathic normal pressure hydrocephalus). Neurol Med Chir 2000; 40(1): 38–46.

23. Walchenbach R, Geiger E, Thomeer R, Vanneste J. The value of temporary external lumbar CSF drainage in predicting the outcome of shunting on normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 2002; 72(4): 503–506.

24. Malm J, Kristensen B, Karlsson T, Fagerlund M, Elfverson J, Ekstedt J. The predictive value of cerebrospinal fluid dynamic tests in patients with th idiopathic adult hydrocephalus syndrome. Arch Neurol 1995; 52(8): 783–789.

25. Haan J, Thomeer R. Predictive value of temporary external lumbar drainage in normal pressure hydrocephalus. Neurosurgery 1988; 22(2): 388–391.

26. Katzman R, Hussey F. A simple constant-infusion manometric test for measurement of CSF absorption. I. Rationale and method. Neurology 1970; 20(6): 534–544.

27. Razay G, Vreugdenhil A, Liddell J. A prospective study of ventriculo-peritoneal shunting for idiopathic normal pressure hydrocephalus. J Clin Neurosci 2009; 16(9): 1180–1183.

28. Kahlon B, Sundbärg G, Rehncrona S. Comparison between the lumbar infusion and CSF tap tests to predict outcome after shunt surgery in suspected normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 2002; 73(6): 721–726.

29. Kahlon B, Sundbärg G, Rehncrona S. Lumbar infusion test in normal pressure hydrocephalus. Acta Neurol Scand 2005; 111(6): 379–384.

30. Dufková E, Dufek M, Chrastina J. Nálezy likvorové cytologie po implantacích stentů po endoskopických operacích. Cesk Slov Neurol N 2002; 65/98(5): ­347–349.

Labels
Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

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