Implementation of a new CSF dynamic device: a multicenter feasibility study in 562 patients

• Published in: Acta neurologica Scandinavica Vol. 125; no. 3; pp. 199 - 205
• Main Authors: Malm, J., Sundström, N., Cesarini, K. G., Edsbagge, M., Kristensen, B., Leijon, G., Eklund, A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-03-2012; Blackwell
• Subjects: Biological and medical sciences; Cerebrospinal fluid; Cerebrospinal fluid dynamics; Cerebrospinal fluid outflow resistance; Cerebrospinal fluid pressure; Cerebrospinal Fluid Pressure - physiology; Cerebrospinal fluid shunts; Cerebrospinal Fluid Shunts - adverse effects; Cerebrospinal Fluid Shunts - instrumentation; Cerebrospinal Fluid Shunts - standards; Cerebrospinal fluid/physiology; Diagnostic Tests, Routine - instrumentation; Diagnostic Tests, Routine - methods; Feasibility Studies; Headache; Human viral diseases; Humans; Hydrocephalus; Hydrocephalus - diagnosis; Hydrocephalus - physiopathology; Hydrocephalus - surgery; Infectious diseases; Infusion Pumps - standards; Infusion Pumps - trends; Infusion test; Intracranial pressure; Manometry - methods; Medical sciences; MEDICIN; MEDICINE; Neurology; Neurosciences; Neurovetenskaper; Normal pressure; physiology; Predictive test; Pressure; Prospective Studies; Reproducibility of Results; Shunts; Surgery; Viral diseases; Viral diseases of the nervous system; Human; Nervous system diseases; hydrocephalus; Multicenter study; Cerebrospinal fluid; Intracranial pressure; cerebrospinal fluid outflow resistance; cerebrospinal fluid pressure; Cerebral disorder; cerebrospinal fluid/physiology; predictive test; Resistance; cerebrospinal fluid dynamics; normal pressure; infusion test; Dynamics; Central nervous system disease; Hydrocephaly; cerebrospinal fluid shunts
• ISSN: 0001-6314; 1600-0404; 1600-0404
• DOI: 10.1111/j.1600-0404.2011.01533.x

Malm J, Sundström N, Cesarini KG, Edsbagge M, Kristensen B, Leijon G, Eklund A. Implementation of a new CSF dynamic device: a multicenter feasibility study in 562 patients. 
Acta Neurol Scand: 2012: 125: 199–205. 
© 2011 John Wiley & Sons A/S.
Objectives –  The cerebrospinal fluid (CSF) infusion test is frequently used when selecting hydrocephalus patients for shunt surgery. Very little has been reported regarding adverse events. We present a prospective feasibility study.
Methods –  Standardized devices for measuring CSF dynamics were built and 562 patients investigated: Needles were placed by lumbar puncture (LP). An automatic CSF infusion protocol was performed. Course of events during the investigation as well as adverse events were registered.
Results –  Preoperative evaluation of normal‐pressure hydrocephalus was the most common indication (63%), followed by evaluation of shunt function (23%) and intracranial pressure recordings (14%). The LP was successfully performed in all but nine cases with 24 patients (4.3%) reporting major discomfort. Ringer infusion was performed in 474 investigations, and a valid measurement of the outflow resistance was received in 439 (93%). During the infusion phase, 17 (4%) patients reported severe headache. Infusion volume was significantly higher in patients having subjective symptoms during the infusion phase compared with those without adverse events. During 269 preoperative CSF tap tests, six (2%) patients had severe headache. Post‐investigational headache was reported by 83 (15%) patients at the 24‐h follow‐up. No serious adverse events were observed.
Conclusion –  Infusion testing was safe and without serious adverse events with a high rate of successful procedures. The investigation was associated with expected mild to moderate discomfort.