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Related Concept Videos

Cerebrospinal Fluid01:21

Cerebrospinal Fluid

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Cerebrospinal fluid (CSF) is a colorless liquid that flows around the brain and the spinal cord, playing a vital role in the protection, support, and overall function of the central nervous system (CNS). CSF production, circulation, and absorption are tightly regulated processes essential for the brain and spinal cord to function properly.
CSF Production
CSF is produced mainly in the choroid plexus, a network of capillaries and ependymal cells located within the ventricular system of the brain....
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Assessment of CSF Dynamics Using Infusion Study: Tips and Tricks.

Gianpaolo Jannelli1, Francesco Calvanese2, Alessandro Pirina3

  • 1Department of Cranial Neurosurgery, Neurological Hospital Pierre Wertheimer, University Hospital of Lyon, Lyon, France; Department of Neurosurgery, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland.

World Neurosurgery
|May 29, 2024
PubMed
Summary

The lumbar infusion study (LIS) offers a more sensitive diagnostic tool for cerebrospinal fluid (CSF) disorders like normal pressure hydrocephalus than the tap test. This review details LIS methods to improve patient selection for shunt surgery.

Keywords:
CSFHydrocephalusICPLumbar infusion testShunt-responseTap test

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Area of Science:

  • Neurosurgery
  • Neurology
  • Nephrology

Background:

  • Diagnosing idiopathic normal pressure hydrocephalus and other cerebrospinal fluid (CSF) disorders is challenging.
  • Shunt surgery is the primary treatment but has significant risks, necessitating precise patient selection.
  • The traditional tap test lacks sensitivity for accurate diagnosis.

Purpose of the Study:

  • To review the physiological basis, indications, and parameters of the lumbar infusion study (LIS).
  • To discuss technical variations and in vivo shunt testing within the LIS procedure.
  • To highlight the benefits of LIS for improving diagnostic accuracy in CSF disorders.

Main Methods:

  • This narrative review synthesizes data from multiple European expert centers.
  • Detailed physiological principles and CSF dynamics parameters measurable by LIS are discussed.
  • Technical aspects, including needle configuration, patient positioning, and measurement sites, are examined.

Main Results:

  • The lumbar infusion study (LIS) provides valuable insights into brain dynamics.
  • LIS offers improved diagnostic sensitivity compared to the tap test for CSF disorders.
  • LIS can be performed with minimal additional morbidity.

Conclusions:

  • The lumbar infusion study (LIS) is an underutilized yet superior diagnostic tool for chronic hydrocephalus and other CSF disorders.
  • Incorporating LIS into screening protocols can enhance patient selection for shunt surgery.
  • Further adoption of LIS can improve outcomes for patients with challenging CSF disorders.