BACKGROUND: Lumbar puncture (LP) is a key diagnostic and therapeutic tool, yet concerns persist about its potential to induce brain herniation, especially in patients with elevated intracranial pressure (ICP). Despite ongoing debate, precise risk factors and pathophysiological mechanisms remain unclear. OBJECTIVE: This systematic review aims to examine the risk of cerebellar and paradoxical brain herniation following LP, evaluate the current evidence regarding its incidence, and discuss the implications for clinical practice as well as show the gaps in research. METHODS: Following PRISMA guidelines, a systematic literature review was conducted using the PubMed (MEDLINE) database. Studies from 1990 to 2024 focusing on bacterial meningitis, idiopathic intracranial hypertension, post-surgical states, and other conditions associated with elevated ICP were included. RESULTS: LP-related herniation was reported in diverse clinical settings, with cerebellar herniation primarily seen in bacterial meningitis and idiopathic intracranial hypertension. Herniation onset varied from minutes to days post-LP. While cranial CT is widely used for risk assessment, its predictive accuracy is debated. CONCLUSIONS: Although LP is relatively safe, herniation risk is highly context-dependent. Clinicians should integrate clinical, radiological, and pathophysiological factors in decision-making. Further research is needed to refine predictive models and establish evidence-based guidelines for high-risk patients.

• Keywords
• Brainstem herniation, Cerebellar herniation, Coning, Lumbar drainage, Lumbar puncture, Paradoxical herniation,
• Publication type
• Journal Article MeSH
• Review MeSH

Preoperative differentiation between responders and non-responders to ventriculoperitoneal (VP) shunting in the treatment of normal pressure hydrocephalus (NPH) remains a significant challenge. Identifying biomarkers in presurgical assessment represents a promising approach to reducing the need for invasive cerebrospinal fluid CSF testing. In this prospective observational study, thirty adult patients were classified into Group A (responders to VP shunting) and Group B (non-responders) based on their responsiveness to invasive CSF testing. The overall clinical condition and Idiopathic NPH (iNPH) scale were assessed at baseline. Additionally, biomarker levels were compared between the two groups. Elevated levels of Neurofilament Light Chain (NfL) and Neurofilament Heavy Chain (NfH) in CSF and a reduced level of beta-amyloid Aβ42 were observed. No significant differences in biomarker levels were found between groups. Individual biomarkers demonstrated only poor predictive value (AUC = 0.37-0.53). Clinical factors were stronger predictors (AUC = 0.642-0.669), with no improvement when combined with all examined biomarkers (AUC = 0.428-0.431). No single biomarker reliably predicted confirmed postoperative shunt responsiveness among patients who underwent VP shunt placement and demonstrated clinical improvement. Clinical factors were stronger predictors, suggesting that patient history and clinical assessment (e.g., the iNPH scale) provide more reliable diagnostic information. Notably, combining biomarkers with clinical factors did not improve predictive accuracy.

• Keywords
• Beta-amyloid, Biomarkers, NSE, NfH, NfL, Normal pressure hydrocephalus, S100B, Tau protein,
• MeSH
• Amyloid beta-Peptides cerebrospinal fluid   MeSH
• Biomarkers * cerebrospinal fluid   MeSH
• Middle Aged MeSH
• Humans MeSH
• Neurofilament Proteins cerebrospinal fluid   MeSH
• Hydrocephalus, Normal Pressure * surgery   cerebrospinal fluid   diagnosis   MeSH
• Peptide Fragments cerebrospinal fluid   MeSH
• Predictive Value of Tests MeSH
• Prospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Ventriculoperitoneal Shunt * methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH
• Names of Substances
• amyloid beta-protein (1-42) MeSH Browser
• Amyloid beta-Peptides MeSH
• Biomarkers * MeSH
• neurofilament protein H MeSH Browser
• neurofilament protein L MeSH Browser
• Neurofilament Proteins MeSH
• Peptide Fragments MeSH

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.

• Keywords
• Children, Hydrocephalus, Infusion testing, Intracranial hypertension, Lumbar infusion test, Pediatric, Pediatric neurosurgery,
• MeSH
• Child MeSH
• Hydrocephalus * diagnosis   MeSH
• Humans MeSH
• Adolescent MeSH
• Child, Preschool MeSH
• Pseudotumor Cerebri * diagnosis   MeSH
• Cerebrospinal Fluid Pressure * physiology   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Child, Preschool MeSH
• Publication type
• Journal Article MeSH
• Review MeSH