{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:55:57Z","timestamp":1790787357427,"version":"4.1.0"},"reference-count":29,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Three to five days of external lumbar drainage (ELD) of CSF is a test for ventriculoperitoneal shunt (VPS) selection in idiopathic normal pressure hydrocephalus (iNPH). The accuracy and complication rates of a shorter (1-day) ELD procedure were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Data of patients with iNPH who underwent 1-day ELD to be selected to undergo VPS placement with a programmable valve in the period from 2005 to 2015 were reviewed. Patients experiencing VPS complications, valve malfunctioning, or with less than 1 year of follow-up were excluded. The ability of 1-day ELD to predict VPS outcome at 1- and 12-month follow-up was assessed by calculating sensitivity, specificity, and positive and negative predictive values.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Of 93 patients who underwent 1-day ELD, 3 did not complete the procedure. Of the remaining 90 patients, 2 experienced transient nerve root irritation. Twenty-four patients had negative test outcomes and 66 had positive test outcomes. Nine negative-outcome patients had intraprocedural headache, which showed 37.5% sensitivity (95% confidence interval [CI] 19.5%\u201359.2%) and 100% specificity (95% CI 93.1%\u2013100%) as predictors of negative 1-day ELD outcome. Sixty-eight patients (6 with negative and 62 with positive outcomes) underwent VPS insertion, which was successful in 0 and 58 patients, respectively, at 1-month follow-up. Test sensitivity and specificity in predicting surgical outcome at 1-month follow-up were 100% (95% CI 92.3%\u2013100%) and 60% (95% CI 27.4%\u201386.3%), respectively, with 94.1% accuracy (95% CI 85.6\u201398.4%). Among the 1-day ELD\u2013positive patients, 2 showed no clinical benefit at 12 months follow-up. Test sensitivity and specificity in predicting surgical outcome at 12-month follow-up was 100% (95% CI 92.5%\u2013100%) and 75.0% (95% CI 35.6%\u201395.5%), respectively, with 97.1% (95% CI 89.8%\u201399.6%) accuracy.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>One-day ELD is a reliable tool in iNPH management, with low complication risk and short trial duration. The test is very consistent in predicting who will have a positive outcome with VPS placement, given the high chance of successful outcome at 1- and 12-month follow-up; negative-outcome patients have a high risk of unsuccessful surgery. Intraprocedural headache is prognostic of 1-day ELD negative outcome.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.6.jns18400","type":"journal-article","created":{"date-parts":[[2019,2,27]],"date-time":"2019-02-27T00:13:27Z","timestamp":1551226407000},"page":"1011-1017","source":"Crossref","is-referenced-by-count":14,"title":["Accuracy and safety of 1-day external lumbar drainage of CSF for shunt selection in patients with idiopathic normal pressure hydrocephalus"],"prefix":"10.3171","volume":"131","author":[{"given":"Pasquale","family":"Gallina","sequence":"first","affiliation":[{"name":"Department of Surgery and Translational Medicine, Neurosurgery Unit, Florence School of Neurosurgery, University of Florence;"},{"name":"Careggi University Hospital, Florence;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giancarlo","family":"Lastrucci","sequence":"additional","affiliation":[{"name":"Department of Surgery and Translational Medicine, Neurosurgery Unit, Florence School of Neurosurgery, University of Florence;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saverio","family":"Caini","sequence":"additional","affiliation":[{"name":"Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute (ISPRO), Florence;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Di Lorenzo","sequence":"additional","affiliation":[{"name":"Department of Surgery and Translational Medicine, Neurosurgery Unit, Florence School of Neurosurgery, University of Florence;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berardino","family":"Porfirio","sequence":"additional","affiliation":[{"name":"Careggi University Hospital, Florence;"},{"name":"Department of Clinical and Experimental Biomedical Sciences \u201cMario Serio,\u201d University of Florence; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Scollato","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, \u201cOspedali Riuniti\u201d of Trieste, Cattinara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1056\/NEJM196507152730301","article-title":"Symptomatic occult hydrocephalus with \u201cnormal\u201d cerebrospinal-fluid pressure. 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