Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2002 Apr;72(4):503–506. doi: 10.1136/jnnp.72.4.503

The value of temporary external lumbar CSF drainage in predicting the outcome of shunting on normal pressure hydrocephalus

R Walchenbach 1, E Geiger 1, R Thomeer 1, J Vanneste 1
PMCID: PMC1737811  PMID: 11909911

Abstract

Objective: It has been reported that temporary external lumbar CSF drainage (ELD) is a very accurate test for predicting the outcome after ventricular shunting in patients with normal pressure hydrocephalus (NPH). However, only a limited number of patients have been studied for assessing the predictive accuracy of ELD. Therefore, the value of ELD in predicting the outcome after a ventriculoperitoneal shunt in patients with presumed NPH was assessed.

Methods: All patients with presumed NPH were invited to participate in this study. Clinical assessment, MRI, and neuropsychological evaluation were followed by a lumbar CSF tap test consisting of removing 40 ml CSF. When this test resulted in marked clinical improvement of gait impairment, mental disturbances, or both, the patient was shunted without further tests. In patients with either questionable or no improvement after the CSF tap test, ELD was carried out. The value of ELD for predicting the outcome after shunting was calculated by correlating the results of ELD with that of ventriculoperitoneal shunting.

Results: Between January 1994 and December 2000, 49 presumed NPH patients from three institutes were included. Forty three had idiopathic, and the remaining six had secondary NPH. Forty eight patients were shunted; 39 had an ELD of whom 38 completed the test. After 2 months 35 of the 48 (73%) shunted patients had improved. The predictive value of a positive ELD was 87% (95% confidence interval (95% CI) 62–98) and that of a negative ELD 36% (95% CI 17–59). In two patients serious test related complications (meningitis) occurred without residual deficit.

Conclusion: The study suggests that although the predictive value of a positive ELD is high, that of a negative ELD is deceptively low because of the high rate of false negative results. The costs and invasiveness of the test and the possibility of serious test related complications further limits its usefulness in managing patients with presumed NPH.

Full Text

The Full Text of this article is available as a PDF (90.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ahlberg J., Norlén L., Blomstrand C., Wikkelsö C. Outcome of shunt operation on urinary incontinence in normal pressure hydrocephalus predicted by lumbar puncture. J Neurol Neurosurg Psychiatry. 1988 Jan;51(1):105–108. doi: 10.1136/jnnp.51.1.105. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bradley W. G., Jr, Kortman K. E., Burgoyne B. Flowing cerebrospinal fluid in normal and hydrocephalic states: appearance on MR images. Radiology. 1986 Jun;159(3):611–616. doi: 10.1148/radiology.159.3.3704142. [DOI] [PubMed] [Google Scholar]
  3. Bradley W. G., Jr, Whittemore A. R., Kortman K. E., Watanabe A. S., Homyak M., Teresi L. M., Davis S. J. Marked cerebrospinal fluid void: indicator of successful shunt in patients with suspected normal-pressure hydrocephalus. Radiology. 1991 Feb;178(2):459–466. doi: 10.1148/radiology.178.2.1987609. [DOI] [PubMed] [Google Scholar]
  4. Bret P., Chazal J., Janny P., Renaud B., Tommasi M., Lemaire J. J., Bret M., Jouvet A. L'hydrocéphalie chronique de l'adulte. Neurochirurgie. 1990;36 (Suppl 1):1–159. [PubMed] [Google Scholar]
  5. Chen I. H., Huang C. I., Liu H. C., Chen K. K. Effectiveness of shunting in patients with normal pressure hydrocephalus predicted by temporary, controlled-resistance, continuous lumbar drainage: a pilot study. J Neurol Neurosurg Psychiatry. 1994 Nov;57(11):1430–1432. doi: 10.1136/jnnp.57.11.1430. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Di Lauro L., Mearini M., Bollati A. The predictive value of 5 days CSF diversion for shunting in normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry. 1986 Jul;49(7):842–843. doi: 10.1136/jnnp.49.7.842-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Folstein M. F., Folstein S. E., McHugh P. R. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6. [DOI] [PubMed] [Google Scholar]
  8. Gyldensted C. Measurements of the normal ventricular system and hemispheric sulci of 100 adults with computed tomography. Neuroradiology. 1977 Dec 31;14(4):183–192. doi: 10.1007/BF00496982. [DOI] [PubMed] [Google Scholar]
  9. Haan J., Thomeer R. T. Predictive value of temporary external lumbar drainage in normal pressure hydrocephalus. Neurosurgery. 1988 Feb;22(2):388–391. doi: 10.1227/00006123-198802000-00020. [DOI] [PubMed] [Google Scholar]
  10. Holodny A. I., Waxman R., George A. E., Rusinek H., Kalnin A. J., de Leon M. MR differential diagnosis of normal-pressure hydrocephalus and Alzheimer disease: significance of perihippocampal fissures. AJNR Am J Neuroradiol. 1998 May;19(5):813–819. [PMC free article] [PubMed] [Google Scholar]
  11. Jack C. R., Jr, Mokri B., Laws E. R., Jr, Houser O. W., Baker H. L., Jr, Petersen R. C. MR findings in normal-pressure hydrocephalus: significance and comparison with other forms of dementia. J Comput Assist Tomogr. 1987 Nov-Dec;11(6):923–931. doi: 10.1097/00004728-198711000-00001. [DOI] [PubMed] [Google Scholar]
  12. Krauss J. K., Regel J. P., Vach W., Jüngling F. D., Droste D. W., Wakhloo A. K. Flow void of cerebrospinal fluid in idiopathic normal pressure hydrocephalus of the elderly: can it predict outcome after shunting? Neurosurgery. 1997 Jan;40(1):67–74. doi: 10.1097/00006123-199701000-00015. [DOI] [PubMed] [Google Scholar]
  13. 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 Aug;52(8):783–789. doi: 10.1001/archneur.1995.00540320059013. [DOI] [PubMed] [Google Scholar]
  14. Sand T., Bovim G., Grimse R., Myhr G., Helde G., Cappelen J. Idiopathic normal pressure hydrocephalus: the CSF tap-test may predict the clinical response to shunting. Acta Neurol Scand. 1994 May;89(5):311–316. doi: 10.1111/j.1600-0404.1994.tb02640.x. [DOI] [PubMed] [Google Scholar]
  15. Vanneste J., Augustijn P., Davies G. A., Dirven C., Tan W. F. Normal-pressure hydrocephalus. Is cisternography still useful in selecting patients for a shunt? Arch Neurol. 1992 Apr;49(4):366–370. doi: 10.1001/archneur.1992.00530280046021. [DOI] [PubMed] [Google Scholar]
  16. Vanneste J., Augustijn P., Dirven C., Tan W. F., Goedhart Z. D. Shunting normal-pressure hydrocephalus: do the benefits outweigh the risks? A multicenter study and literature review. Neurology. 1992 Jan;42(1):54–59. doi: 10.1212/wnl.42.1.54. [DOI] [PubMed] [Google Scholar]
  17. Vanneste J., Augustijn P., Tan W. F., Dirven C. Shunting normal pressure hydrocephalus: the predictive value of combined clinical and CT data. J Neurol Neurosurg Psychiatry. 1993 Mar;56(3):251–256. doi: 10.1136/jnnp.56.3.251. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Wikkelsö C., Andersson H., Blomstrand C., Lindqvist G., Svendsen P. Normal pressure hydrocephalus. Predictive value of the cerebrospinal fluid tap-test. Acta Neurol Scand. 1986 Jun;73(6):566–573. doi: 10.1111/j.1600-0404.1986.tb04601.x. [DOI] [PubMed] [Google Scholar]
  19. Wikkelsø C., Andersson H., Blomstrand C., Lindqvist G. The clinical effect of lumbar puncture in normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry. 1982 Jan;45(1):64–69. doi: 10.1136/jnnp.45.1.64. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES