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Supplementary tests in idiopathic normal pressure hydrocephalus: a single center experience with a combined lumbar infusion test and tap test.
World Neurosurg. 2017 Jan 09;:
Authors: Raneri F, Zella MA, Di Cristofori A, Zarrino B, Pluderi M, Spagnoli D
Abstract
INTRODUCTION: Lumbar infusion test (LIT) and Tap Test (TT) have previously been described for the diagnosis and the selection of appropriate surgical candidates in idiopathic normal pressure hydrocephalus (iNPH) MATERIALS AND METHODS: We retrospectively reviewed 81 consecutive patients with clinical diagnosis of iNPH selected for supplementary testing. Clinical evaluation was scored with the Japanese Grading Scale for Normal Pressure Hydrocephalus (JGSNPH), the Global Deterioration Score (GDS) and the modified Rankin Scale (mRS). The test protocol included a CSF pressure monitoring (PMi), a LIT and a TT. Patients were selected for surgery if outflow resistance (Ro) ≥ 14 mmHg/ml/min or if a clinical improvement was recorded after TT.
RESULTS: 68 patients were selected for VP shunting. 72.8% had a positive PMi or LIT, 74.1% had a positive TT and 63.0 % were positive to both tests. Complications were all transient. Clinical evaluation at 12 months after shunting showed a global improvement in 60 (88.2%) patients. Overall 75.0% of patients had no significant disability (mRS 1 and 2), 20.6 % had a mRS of 3 or 4 and 4.4% had severe disability after surgery. The PPV of PMi/LIT, TT or both combined were similar (89.8, 90.0 and 88.2%), however 21.7% of patients who improved after surgery were selected with either a positive LIT or TT alone.
CONCLUSIONS: LIT and TT are complementary and they can easily be combined in sequence with a low complication rate and high probability of selecting iNPH patients who may benefit from a VP shunt surgery.
PMID: 28089835 [PubMed - as supplied by publisher]
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