BACKGROUND: The lumbar infusion test (LIT) is a routine part of the diagnostic process of various CSF dynamics disorders in adults. However, it is rarely used in the paediatric population due to a lack of evidence substantiating its efficacy and overall indications. METHODS: Articles utilizing the LIT in a paediatric cohort (≤ 18 years) were included according to the PRISMA guidelines with the Newcastle-Ottawa Scale to assess the risk of bias. This review was registered at PROSPERO database under number: CRD42024625857. RESULTS: A total of 15 studies, yielding 441 patients, were included in the review. The most common indications for LIT were to predict shunt responsiveness in hydrocephalus and idiopathic intracranial hypertension (IIH). In IIH, the interaction between cerebrospinal fluid pressure (CSFp) and sagittal sinus pressure (SSp) may offer valuable diagnostic insights and present a novel assessment approach. The LIT is a validated tool, especially effective for predicting shunt responsiveness and detecting malfunctions in both IIH and hydrocephalus. CONCLUSIONS: Data surrounding LIT usage in children is lacking and most studies are outdated. Caution is needed when interpreting resistance to outflow (Rout) due to potential overestimation, with more attention directed to CSFp and the pressure within the venous system coupling in IIH. Future studies should focus on standardizing LIT protocols across age groups with focusing more on signal characteristics rather than individual parameters and fostering interdisciplinary collaboration to optimize diagnostic accuracy.

Department of Cardiovascular Medicine 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Prague Czech Republic

Department of Clinical Neurosciences Division of Neurosurgery Brain Physics Laboratory University of Cambridge and Cambridge University Hospital NHS Foundation Trust Cambridge UK

Department of Cognitive Systems and Neurosciences Robotics and Cybernetics Czech Institute of Informatics Czech Technical University Prague Czech Republic

Department of Neurology King's College Hospital NHS Foundation Trust London UK

Department of Neurosurgery 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

Department of Radiation Sciences Faculty of Medicine Umeå University Umeå Sweden

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