Predictive Value of Temporary External Lumbar Drainage in Normal Pressure Hydrocephalus

Abstract In a prospective study on the effect of shunting, 22 patients diagnosed as suffering from normal pressure hydrocephalus (NPH) were investigated by means of temporary external lumbar drainage (ELD). Five patients had to be excluded from the study because of complications of ELD or definitive shunting. ELD correctly predicted the outcome of shunting in all of the remaining 17 patients. The value of external lumbar drainage in NPH is discussed on the basis of personal experience and data from the literature. It seems to be a safe and valuable tool for predicting the outcome of definitive shunting procedures. (Neurosurgery 22:388-391, 1988)

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Predictive value of temporary external lumbar drainage in normal pressure hydrocephalus

Neurosurgery ◽

10.1097/00006123-198802000-00020 ◽

1988 ◽

Vol 22 (2) ◽

pp. 388???91 ◽

Cited By ~ 2

Author(s):

J Haan ◽

R T Thomeer

Keyword(s):

Normal Pressure Hydrocephalus ◽

Predictive Value ◽

Normal Pressure ◽

Lumbar Drainage ◽

External Lumbar Drainage

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A prospective study on gait dominant normal pressure hydrocephalus

Acta Neurologica Scandinavica ◽

10.1111/ane.13064 ◽

2019 ◽

Vol 139 (4) ◽

pp. 389-394 ◽

Cited By ~ 1

Author(s):

Melissa Song ◽

Abraham Lieberman ◽

Terry Fife ◽

Megan Nielsen ◽

Sharon Hayden ◽

...

Keyword(s):

Prospective Study ◽

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

A Prospective Study

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A prospective study on gait dominant normal pressure hydrocephalus

Acta Neurologica Scandinavica ◽

10.1111/ane.13165 ◽

2019 ◽

Vol 141 (3) ◽

pp. 257-257

Author(s):

Reihaneh Zavar ◽

Afshin Amirpour ◽

Javad Shahabi

Keyword(s):

Prospective Study ◽

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

A Prospective Study

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Accuracy and safety of 1-day external lumbar drainage of CSF for shunt selection in patients with idiopathic normal pressure hydrocephalus

Journal of Neurosurgery ◽

10.3171/2018.6.jns18400 ◽

2019 ◽

Vol 131 (4) ◽

pp. 1011-1017

Author(s):

Pasquale Gallina ◽

Giancarlo Lastrucci ◽

Saverio Caini ◽

Nicola Di Lorenzo ◽

Berardino Porfirio ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Normal Pressure Hydrocephalus ◽

Surgical Outcome ◽

Normal Pressure ◽

Lumbar Drainage ◽

Test Sensitivity ◽

Test Outcomes ◽

External Lumbar Drainage ◽

Negative Outcome

OBJECTIVEThree to five days of external lumbar drainage (ELD) of CSF is a test for ventriculoperitoneal shunt (VPS) selection in idiopathic normal pressure hydrocephalus (iNPH). The accuracy and complication rates of a shorter (1-day) ELD procedure were analyzed.METHODSData of patients with iNPH who underwent 1-day ELD to be selected to undergo VPS placement with a programmable valve in the period from 2005 to 2015 were reviewed. Patients experiencing VPS complications, valve malfunctioning, or with less than 1 year of follow-up were excluded. The ability of 1-day ELD to predict VPS outcome at 1- and 12-month follow-up was assessed by calculating sensitivity, specificity, and positive and negative predictive values.RESULTSOf 93 patients who underwent 1-day ELD, 3 did not complete the procedure. Of the remaining 90 patients, 2 experienced transient nerve root irritation. Twenty-four patients had negative test outcomes and 66 had positive test outcomes. Nine negative-outcome patients had intraprocedural headache, which showed 37.5% sensitivity (95% confidence interval [CI] 19.5%–59.2%) and 100% specificity (95% CI 93.1%–100%) as predictors of negative 1-day ELD outcome. Sixty-eight patients (6 with negative and 62 with positive outcomes) underwent VPS insertion, which was successful in 0 and 58 patients, respectively, at 1-month follow-up. Test sensitivity and specificity in predicting surgical outcome at 1-month follow-up were 100% (95% CI 92.3%–100%) and 60% (95% CI 27.4%–86.3%), respectively, with 94.1% accuracy (95% CI 85.6–98.4%). Among the 1-day ELD–positive patients, 2 showed no clinical benefit at 12 months follow-up. Test sensitivity and specificity in predicting surgical outcome at 12-month follow-up was 100% (95% CI 92.5%–100%) and 75.0% (95% CI 35.6%–95.5%), respectively, with 97.1% (95% CI 89.8%–99.6%) accuracy.CONCLUSIONSOne-day ELD is a reliable tool in iNPH management, with low complication risk and short trial duration. The test is very consistent in predicting who will have a positive outcome with VPS placement, given the high chance of successful outcome at 1- and 12-month follow-up; negative-outcome patients have a high risk of unsuccessful surgery. Intraprocedural headache is prognostic of 1-day ELD negative outcome.

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