{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T11:12:49Z","timestamp":1777893169402,"version":"3.51.4"},"reference-count":20,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n External lumbar drainage (ELD) is definitely a known predictor of ventriculoperitoneal shunt (VPS) outcome in normal pressure hydrocephalus (NPH). However, the speed of clinical response following ELD has not been studied well enough to predict shunt outcome. This study aims to assess the predictive value of ELD response for VP shunt outcome.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n A prospective observational study of 67 patients diagnosed with NPH based on clinical and radiological criteria. All patients underwent ELD, and the time to improvement in gait after ELD was calculated. Those who showed improvement within 72 h were defined as early responders, those who showed improvement after 72 h as delayed responders, and those who did not show improvement as nonresponders. Early and delayed responders were given VPS surgery. Postsurgery results were assessed clinically on follow-up. Both multivariate and univariate penalized Firth regression was conducted to determine the predictive value of the speed of clinical response on the outcome of VPS. A receiver operating characteristic (ROC) curve analysis was done to assess the discriminative power of the model. A Hosmer\u2013Lemeshow test was done to see the calibration.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Clinical response following ELD was a significant predictor of VP shunt outcome (\n P<\/jats:italic>\n < 0.001). Univariate Firth regression analysis demonstrated that delayed responders had significantly higher odds of poor shunt outcome as compared with early responders (odds ratio = 96.2). ROC analysis demonstrated good discriminative ability for the shunt outcome. Hosmer\u2013Lemeshow showed good calibration (\n P<\/jats:italic>\n = 0.832).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Time to gait improvement following ELD may aid patient selection and surgical decision-making among patients undergoing VPS after ELD responsiveness.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_189_2026","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T06:50:23Z","timestamp":1777618223000},"page":"248","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Speed of clinical response to external lumbar drainage as a predictor of outcome of ventriculoperitoneal shunt in normal pressure hydrocephalus: A prospective cohort study"],"prefix":"10.25259","volume":"17","author":[{"given":"M. S.","family":"Bhuiyan","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Zainul Haque Sikder Women\u2019s Medical College and Hospital, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Umma Ammara","family":"Hoque","sequence":"additional","affiliation":[{"name":"Intern Doctor, Zainul Haque Sikder Women\u2019s Medical College and Hospital, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2026,5,1]]},"reference":[{"key":"10.25259\/SNI_189_2026\/ref-1","article-title":"Accuracy of CSF Tap Test and Lumbar Infusion Test in Predicting Shunt Response in Idiopathic Normal Pressure Hydrocephalus: A Systematic Review and Meta-Analysis","author":"Aliyar","year":"2025"},{"key":"10.25259\/SNI_189_2026\/ref-2","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1186\/s12893-025-02895-9","article-title":"Long-term outcomes of ventriculoperitoneal shunt therapy in idiopathic normal pressure hydrocephalus","volume":"25","author":"Chen","year":"2025","journal-title":"BMC Surg"},{"key":"10.25259\/SNI_189_2026\/ref-3","doi-asserted-by":"crossref","first-page":"12","DOI":"10.4103\/2152-7806.125860","article-title":"External lumbar drain: A pragmatic test for prediction of shunt outcomes in idiopathic normal pressure hydrocephalus","volume":"5","author":"Chotai","year":"2014","journal-title":"Surg Neurol Int"},{"key":"10.25259\/SNI_189_2026\/ref-4","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1212\/CPJ.0000000000001156","article-title":"CSF biomarkers predict gait outcomes in idiopathic normal pressure hydrocephalus","volume":"12","author":"Darrow","year":"2022","journal-title":"Neurol Clin Pract"},{"key":"10.25259\/SNI_189_2026\/ref-5","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1002\/ana.25046","article-title":"Deconstructing normal pressure hydrocephalus: Ventriculomegaly as early sign of 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pressure hydrocephalus","volume":"131","author":"Gallina","year":"2018","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_189_2026\/ref-9","article-title":"Greenberg\u2019s Handbook of Neurosurgery","author":"Greenberg","year":"2023","edition":"10th ed"},{"key":"10.25259\/SNI_189_2026\/ref-10","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1080\/02688697.2022.2149697","article-title":"Endoscopic third ventriculostomy compared to ventriculoperitoneal shunt as treatment for idiopathic normal pressure hydrocephalus: A systematic review and meta-analysis","volume":"38","author":"Greuter","year":"2024","journal-title":"Br J Neurosurg"},{"key":"10.25259\/SNI_189_2026\/ref-11","doi-asserted-by":"crossref","first-page":"959450","DOI":"10.3389\/fneur.2022.959450","article-title":"Are preoperative phase-contrast CSF flow parameters ideal for predicting the outcome of shunt surgery in patients with idiopathic normal pressure hydrocephalus?","volume":"13","author":"He","year":"2022","journal-title":"Front Neurol"},{"key":"10.25259\/SNI_189_2026\/ref-12","doi-asserted-by":"crossref","first-page":"591","DOI":"10.3171\/2015.8.JNS151112","article-title":"Idiopathic normal pressure hydrocephalus: Diagnostic and predictive value of clinical testing, lumbar drainage, and CSF dynamics","volume":"125","author":"Mahr","year":"2016","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_189_2026\/ref-13","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1007\/s10143-025-03582-2","article-title":"Advancing treatment strategies for idiopathic normal pressure hydrocephalus: A systematic review on studies comparing ventricular and lumbo-peritoneal shunts","volume":"48","author":"Palermo","year":"2025","journal-title":"Neurosurg Rev"},{"key":"10.25259\/SNI_189_2026\/ref-14","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1055\/s-0043-1771370","article-title":"Treatment of idiopathic normal pressure hydrocephalus with a novel programmable valve: Prospective Evaluation of costs, efficacy, and safety","volume":"18","author":"Reis","year":"2023","journal-title":"Asian J Neurosurg"},{"key":"10.25259\/SNI_189_2026\/ref-15","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1007\/s00701-022-05402-8","article-title":"Radiological predictors of shunt response in the diagnosis and treatment of idiopathic normal pressure hydrocephalus: A systematic review and meta-analysis","volume":"165","author":"Thavarajasingam","year":"2022","journal-title":"Acta Neurochir (Wien)"},{"key":"10.25259\/SNI_189_2026\/ref-16","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.3390\/jcm11051286","article-title":"Clinical outcomes of shunting in normal pressure hydrocephalus: A multicenter prospective observational study","volume":"11","author":"Trungu","year":"2022","journal-title":"J Clin 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