Department of Cranial Neurosurgery, Neurological Hospital Pierre Wertheimer, University Hospital of Lyon, Lyon, France; Department of Neurosurgery, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland.
Department of Cranial Neurosurgery, Neurological Hospital Pierre Wertheimer, University Hospital of Lyon, Lyon, France; Department of spine and robotic surgery, Humanitas San Pio X Hospital, Milan, Italy.
World Neurosurg. 2024 Sep;189:33-41. doi: 10.1016/j.wneu.2024.05.131. Epub 2024 May 27.
Idiopathic normal pressure hydrocephalus, secondary chronic hydrocephalus, and other cerebrospinal fluid (CSF) disorders are often challenging to diagnose. Since shunt surgery is usually the only therapeutic option and carries significant morbidity, optimal patient selection is crucial. The tap test is the most commonly used prognostic test to confirm the diagnosis but lacks sensitivity. The lumbar infusion study (LIS) appears to be a better option, offering additional information on brain dynamics without increasing morbidity. However, this technique remains underused. In this narrative review, supported by the extensive experience of several European expert centers, we detail the physiological basis, indications, and CSF dynamics parameters that can be measured. We also discuss technical modalities and variations, including one versus 2 needles, patient positioning, and the site of CSF measurement, as well as in vivo shunt testing. Finally, we discuss the limitations and morbidity associated with the LIS. This review aims to assist teams wishing to incorporate LIS into their screening tools for chronic hydrocephalus and other CSF disorders.
特发性正常压力脑积水、继发性慢性脑积水和其他脑脊液（CSF）疾病的诊断往往具有挑战性。由于分流手术通常是唯一的治疗选择，且具有显著的发病率，因此最佳的患者选择至关重要。腰椎穿刺试验是最常用的预后试验，用于确认诊断，但缺乏敏感性。腰椎输注试验（LIS）似乎是一个更好的选择，它提供了关于脑动力学的更多信息，而不会增加发病率。然而，这项技术的应用仍然不足。在这篇叙述性综述中，我们详细介绍了腰椎穿刺试验的生理基础、适应证和可测量的 CSF 动力学参数，这些内容得到了几个欧洲专家中心的丰富经验的支持。我们还讨论了技术方式和变化，包括一针与两针、患者体位和 CSF 测量部位，以及体内分流试验。最后，我们讨论了腰椎穿刺试验的局限性和发病率。本综述旨在帮助希望将腰椎穿刺试验纳入慢性脑积水和其他 CSF 疾病筛查工具的团队。
