• Gianpaolo Jannelli, Francesco Calvanese, Alessandro Pirina, Laurent Gergelé, Alexandra Vallet, Giorgio Palandri, Marek Czosnyka, Zofia Czosnyka, and Romain Manet.
• Department of Cranial Neurosurgery, Neurological Hospital Pierre Wertheimer, University Hospital of Lyon, Lyon, France; Department of Neurosurgery, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland.
• World Neurosurg. 2024 Sep 1; 189: 334133-41.

AbstractIdiopathic 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.Copyright © 2024 Elsevier Inc. All rights reserved.

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