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Review
. 2025 Jun 30;167(1):180.
doi: 10.1007/s00701-025-06591-8.

The diagnostic value of the lumbar infusion test to predict symptomatic improvement after shunting for normal pressure hydrocephalus. A meta-analysis

M W T van Bilsen  1   2 , V Volovici  3   4 , S Arts  5 , L van den Abbeele  6 , H D Boogaarts  6 , R H M A Bartels  6 , E J van Lindert  6
Affiliations
Review

The diagnostic value of the lumbar infusion test to predict symptomatic improvement after shunting for normal pressure hydrocephalus. A meta-analysis

M W T van Bilsen et al. Acta Neurochir (Wien). .

Abstract

Background: The aim of this meta-analysis is to determine the diagnostic value of the Lumbar Infusion Test (LIT) to differentiate between patients suffering from normal pressure hydrocephalus who will benefit from CSF shunting and those who will not.

Methods: A systematic search was performed in Ovid MEDLINE to identify RCTs or observational studies that evaluated LIT for predicting shunt responsiveness. Sensitivity and specificity values were pooled and Bayesian meta-analysis was performed.

Results: The Resistance to outflow (Rout) sensitivity was 76.9%; 81.6% and 36.6% for a Rout cut off of respectively 12, 14 and 18 mmHg/ml/min. Specificity rose with higher Rout cut off and was 34.0%; 37.2% and 78.0% for a cut off of respectively 12, 14 and 18 mmHg/ml/min. The negative predictive value was low for each cut off and was at most 33.3%.

Conclusion: The LIT proves poor negative predictive value and appears an ineffective tool in the prediction of non-response to a shunting procedure. Therefore, in its present form and based on its current parameters, it cannot be used as a test to exclude patients from shunt implantation.

Keywords: Diagnostic value; Lumbar infusion test; Normal pressure hydrocephalus; Sensitivity; Shunting; Specificity.

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Conflict of interest statement

Declarations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Example of a LIT measurement reading. a = plateau pressure (mmHg); b = initial pressure (mmHg); c = initial pressure amplitude (mmHg); d = plateau pressure amplitude(mmHg); Rout = (a-b)/infusion rate. First peak occurs because of a lumbar puncture in a sitting position. Dip at 20 min occurs due to aspiration of CSF by the registered nurse before the initiation of infusion. Blue line, infused volume in ml; red line pressure in mmHg
Fig. 2
Fig. 2
Results of the predictive surfaces of the Bayesian diagnostic meta-analysis with a bivariate normal distribution of LIT studies, random effect model and weakly informative priors. The plots show the results after 10,000 simulations. The blue points in the graph indicate the distribution of simulated studies. The red contours indicate the predictive surfaces of the 50%, 75% and 95% quantiles of these studies. The histograms show the posterior distribution of predicted values for these studies in terms of false positive rate (x-axis, above the graph) and sensitivity (y-axis, on the right side of the graph). TPR, true positive rate; FPR, false positive rate
See this image and copyright information in PMC

References

    1. Andersson J, Rosell M, Kockum K, Lilja-Lund O, Söderström L, Laurell K (2019) Prevalence of idiopathic normal pressure hydrocephalus: A prospective, population-based study. PLoS ONE 14(5):e0217705 - PMC - PubMed
    1. Bådagård H, Braun M, Nilsson D, Stridh L, Virhammar J (2020) Negative predictors of shunt surgery outcome in normal pressure hydrocephalus. Acta Neurol Scand 141(3):219–225 - PubMed
    1. Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA et al (1997) Dutch normal-pressure hydrocephalus study: prediction of outcome after shunting by resistance to outflow of cerebrospinal fluid. J Neurosurg 87(5):687–693 - PubMed
    1. clinicaltrials.gov. Conservative Versus Surgical Management of Idiopathic Normal Pressure Hydrocephalus (INPH). 2018.
    1. Czepko R, Cieslicki K (2016) Repeated assessment of suspected normal pressure hydrocephalus in non-shunted cases. A prospective study based on the constant rate lumbar infusion test. Acta Neurochirurgica 158(5):855–863 - PubMed

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