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Intraventricular or lumbar infusion test in adult communicating hydrocephalus? Practical consequences and clinical outcome of shunt operation.
Acta Neurochir (Wien). 2005 Oct; 147(10):1027-35; discussion 1035-6.AN

Abstract

BACKGROUND

To investigate the therapeutic consequences of restricting the CSF dynamic evaluation to a lumbar infusion test (LIT), as opposed to our formerly applied intraventricular assessment (VIT), in patients with communicating hydrocephalus (CH).

METHOD

All patients over 18 years of age referred with clinical and radiological indication of treatment-requiring secondary CH (n = 50) or idiopathic normal-pressure hydrocephalus (INPH, n = 33) were subjected to a LIT. Subsequently, a combination of the results of the LIT (mainly the resistance to CSF outflow) and the clinical presentation determined whether to proceed with (a) VIT before a decision about shunt surgery, (b) shunt surgery or (c) no further diagnostic investigation or surgery.

FINDINGS

In 88 percent of the patients with secondary CH and 80 percent of the patients with INPH the decision on shunt surgery was made after performing exclusively a LIT. The shunting success rate was 90 percent in patients with secondary CH and 82 percent in patients with INPH, which however in the latter group decreased to 76 percent, when including the patients undergoing an additional VIT. The achieved shunt success rates are equal or better, compared to the results from previous studies using intraventricular assessment.

CONCLUSIONS

LIT and VIT are equally reliable for selecting shunt responsive patients with CH, using clinical improvement rate as the main criterion for comparison. The practical and economic consequences are substantial: the LIT can be performed in an outpatient setting, whereas VIT necessitates hospitalisation for 1-2 days including occupation of the neurosurgical theatre and postoperative neuro-intensive monitoring.

Authors+Show Affiliations

University Clinic of Neurosurgery, The Neuroscience Center, Rigshospitalet, H:S, Copenhagen, Denmark. rbechazeddine@dadlnet.dkNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16044359

Citation

Bech-Azeddine, R, et al. "Intraventricular or Lumbar Infusion Test in Adult Communicating Hydrocephalus? Practical Consequences and Clinical Outcome of Shunt Operation." Acta Neurochirurgica, vol. 147, no. 10, 2005, pp. 1027-35; discussion 1035-6.
Bech-Azeddine R, Gjerris F, Waldemar G, et al. Intraventricular or lumbar infusion test in adult communicating hydrocephalus? Practical consequences and clinical outcome of shunt operation. Acta Neurochir (Wien). 2005;147(10):1027-35; discussion 1035-6.
Bech-Azeddine, R., Gjerris, F., Waldemar, G., Czosnyka, M., & Juhler, M. (2005). Intraventricular or lumbar infusion test in adult communicating hydrocephalus? Practical consequences and clinical outcome of shunt operation. Acta Neurochirurgica, 147(10), 1027-35; discussion 1035-6.
Bech-Azeddine R, et al. Intraventricular or Lumbar Infusion Test in Adult Communicating Hydrocephalus? Practical Consequences and Clinical Outcome of Shunt Operation. Acta Neurochir (Wien). 2005;147(10):1027-35; discussion 1035-6. PubMed PMID: 16044359.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intraventricular or lumbar infusion test in adult communicating hydrocephalus? Practical consequences and clinical outcome of shunt operation. AU - Bech-Azeddine,R, AU - Gjerris,F, AU - Waldemar,G, AU - Czosnyka,M, AU - Juhler,M, Y1 - 2005/08/01/ PY - 2004/07/08/received PY - 2005/06/08/accepted PY - 2005/7/27/pubmed PY - 2006/9/30/medline PY - 2005/7/27/entrez SP - 1027-35; discussion 1035-6 JF - Acta neurochirurgica JO - Acta Neurochir (Wien) VL - 147 IS - 10 N2 - BACKGROUND: To investigate the therapeutic consequences of restricting the CSF dynamic evaluation to a lumbar infusion test (LIT), as opposed to our formerly applied intraventricular assessment (VIT), in patients with communicating hydrocephalus (CH). METHOD: All patients over 18 years of age referred with clinical and radiological indication of treatment-requiring secondary CH (n = 50) or idiopathic normal-pressure hydrocephalus (INPH, n = 33) were subjected to a LIT. Subsequently, a combination of the results of the LIT (mainly the resistance to CSF outflow) and the clinical presentation determined whether to proceed with (a) VIT before a decision about shunt surgery, (b) shunt surgery or (c) no further diagnostic investigation or surgery. FINDINGS: In 88 percent of the patients with secondary CH and 80 percent of the patients with INPH the decision on shunt surgery was made after performing exclusively a LIT. The shunting success rate was 90 percent in patients with secondary CH and 82 percent in patients with INPH, which however in the latter group decreased to 76 percent, when including the patients undergoing an additional VIT. The achieved shunt success rates are equal or better, compared to the results from previous studies using intraventricular assessment. CONCLUSIONS: LIT and VIT are equally reliable for selecting shunt responsive patients with CH, using clinical improvement rate as the main criterion for comparison. The practical and economic consequences are substantial: the LIT can be performed in an outpatient setting, whereas VIT necessitates hospitalisation for 1-2 days including occupation of the neurosurgical theatre and postoperative neuro-intensive monitoring. SN - 0001-6268 UR - https://www.unboundmedicine.com/medline/citation/16044359/Intraventricular_or_lumbar_infusion_test_in_adult_communicating_hydrocephalus_Practical_consequences_and_clinical_outcome_of_shunt_operation_ L2 - https://dx.doi.org/10.1007/s00701-005-0589-0 DB - PRIME DP - Unbound Medicine ER -