{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T14:51:49Z","timestamp":1761490309609},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Spinal CSF leakage causes spontaneous intracranial hypotension (SIH). The aim of this study was to characterize CSF dynamics via lumbar infusion testing in patients with and without proven spinal CSF leakage in order to explore possible discriminators for the presence of an open CSF leak.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>This analysis included all patients with suspected SIH who were treated at the authors\u2019 institution between January 2012 and February 2015. The gold standard for \u201cproven\u201d CSF leakage is considered to be extrathecal contrast accumulation after intrathecal contrast injection. To characterize CSF dynamics, the authors performed computerized lumbar infusion testing to measure lumbar pressure at baseline (opening pressure) and at plateau, as well as pulse amplitude, CSF outflow resistance (R<jats:sub>CSF<\/jats:sub>), craniospinal elastance, and pressure-volume index.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Thirty-one patients underwent clinical imaging and lumbar infusion testing and were included in the final analysis. A comparison of the 14 patients with proven CSF leakage with the 17 patients without leakage showed a statistically significantly lower lumbar opening pressure (p &lt; 0.001), plateau pressure (p &lt; 0.001), and R<jats:sub>CSF<\/jats:sub> (p &lt; 0.001) in the group with leakage. Sensitivity, specificity, and positive and negative predictive values for an R<jats:sub>CSF<\/jats:sub> cutoff of \u2264 5 mm Hg\/(ml\/min) were 0.86, 1.0, 1.0, and 0.89 (area under the curve of 0.96), respectively. The median pressure-volume index was higher (p = 0.003), and baseline (p = 0.017) and plateau (p &lt; 0.001) pulse amplitudes were lower in patients with a proven leak.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Lumbar infusion testing captures a distinct pattern of CSF dynamics associated with spinal CSF leakage. R<jats:sub>CSF<\/jats:sub> assessed by computerized lumbar infusion testing has an excellent diagnostic accuracy and is more accurate than evaluating the lumbar opening pressure. 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