{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T20:13:07Z","timestamp":1792613587463,"version":"4.5.0"},"reference-count":23,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The aim of the study was to analyze the diagnostic and predictive values of clinical tests, CSF dynamics, and intracranial pulsatility tests, compared with external lumbar drainage (ELD), for shunt response in patients with idiopathic normal pressure hydrocephalus (iNPH).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Sixty-eight consecutive patients with suspected iNPH were prospectively evaluated. Preoperative assessment included clinical tests, overnight intracranial pressure (ICP) monitoring, lumbar infusion test (LIFT), and ELD for 24\u201372 hours. Simple and multiple linear regression analyses were conducted to identify predictive parameters concerning the outcome after shunt therapy.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Positive response to ELD correctly predicted improvement after CSF diversion in 87.9% of the patients. A Mini\u2013Mental State Examination (MMSE) value below 21 was associated with nonresponse after shunt insertion (specificity 93%, sensitivity 67%). Resistance to outflow of CSF (ROut) &gt; 12 mm Hg\/ml\/min was false negative in 21% of patients. Intracranial pulsatility parameters yielded different results in various parameters (correlation coefficient between pulse amplitude and ICP, slow wave amplitude, and mean ICP) but did not correlate to outcome. In multiple linear regression analysis, a calculation of presurgical MMSE versus the value after ELD, ROut, and ICP amplitude quotient during LIFT was significantly associated with outcome (p = 0.04).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Despite a multitude of invasive tests, presurgical clinical testing and response to ELD yielded the best prediction for improvement of symptoms following surgery. The complication rate of invasive testing was 5.4%. Multiple and simple linear regression analyses indicated that outcome can only be predicted by a combination of parameters, in accordance with a multifactorial pathogenesis of iNPH.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2015.8.jns151112","type":"journal-article","created":{"date-parts":[[2016,1,29]],"date-time":"2016-01-29T15:03:24Z","timestamp":1454079804000},"page":"591-597","source":"Crossref","is-referenced-by-count":48,"title":["Idiopathic normal pressure hydrocephalus: diagnostic and predictive value of clinical testing, lumbar drainage, and CSF dynamics"],"prefix":"10.3171","volume":"125","author":[{"given":"Cynthia V.","family":"Mahr","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Dengl","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf","family":"Nestler","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Reiss-Zimmermann","sequence":"additional","affiliation":[{"name":"Neuroradiology, University Hospital Leipzig; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerrit","family":"Eichner","sequence":"additional","affiliation":[{"name":"Mathematical Institute, Justus-Liebig University Gie\u00dfen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Preu\u00df","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Meixensberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns151112","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1136\/jnnp-2013-306117","article-title":"Natural course of idiopathic normal pressure hydrocephalus","volume":"85","author":"Andr\u00e9n","year":"2014"},{"issue":"4","key":"b2-jns151112","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Pulse pressure waveform in hydrocephalus: what it is and what it isn't","volume":"22","author":"Czosnyka","year":"2007"},{"issue":"5","key":"b3-jns151112","series-title":"Neurosurg Focus","first-page":"E10","article-title":"Intracranial pressure: more than a number","volume":"22","author":"Czosnyka","year":"2007"},{"key":"b4-jns151112","series-title":"Acta Neurochir Suppl","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1007\/3-211-32318-X_50","article-title":"Clinical testing of CSF circulation in hydrocephalus","volume":"95","author":"Czosnyka","year":"2005"},{"key":"b5-jns151112","series-title":"Acta Neurochir Suppl","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1007\/978-3-211-85578-2_28","article-title":"Pulse amplitude of intracranial pressure waveform in hydrocephalus","volume":"102","author":"Czosnyka","year":"2008"},{"key":"b6-jns151112","series-title":"Cerebrospinal Fluid Res","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/1743-8454-7-5","article-title":"Cerebrospinal fluid pulse pressure amplitude during lumbar infusion in idiopathic normal pressure hydrocephalus can predict response to shunting","volume":"7","author":"Eide","year":"2010"},{"key":"b7-jns151112","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"1044","DOI":"10.1136\/jnnp.54.12.1044","article-title":"The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results","volume":"54","author":"Farrell","year":"1991"},{"key":"b8-jns151112","series-title":"J Psychiatr Res","first-page":"189","article-title":"\u201cMini-mental state\u201d. 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