Abstract
BackgroundMechanical obstruction of ventriculoperitoneal shunt (VPS) during the first year after shunt implantation is a common complication and is widely described in the literature. In this paper, we evaluated the suitability of the shuntography for the diagnosis of mechanical complications of the VPS in patients with idiopathic normal pressure hydrocephalus (iNPH).MethodsWe retrospectively identified 49 patients with pathologic shuntography over of a period of 20 years in our hospital. The percentage of procedure-associated complications was determined.ResultsNinety-eight percent (n = 48) of the patients who underwent shuntography showed clinical and radiographic signs of underdrainage prior to examination. Shuntography revealed mechanical complications of the VP shunt in 37% (n = 18) as a cause of clinical deterioration and following revision operation. During shuntography, mechanical obstruction was discovered in 78% (n = 14) and disconnection of shunt components in 22% (n = 4). In the obstruction group, in 50% (n = 7) the closure was detected in the ventricular catheter, in 29% (n = 4) in the distal catheter of the VPS, and in 21% (n = 3) in both sides of the VPS. In the case of an inconspicuous shuntography (63%, n = 31), the patients received symptomatic therapy (32%, n = 10) or re-adjustment of the valve setting (68%, n = 21). Fifty-seven percent of the patients who underwent surgical treatment improved clinically by at least one point according to the Kiefer score.ConclusionShuntography can produce valuable clinical information uncovering mechanic complications after implantation VPS in patients with idiopathic normal-pressure hydrocephalus. Patients with mechanical complications of their VPS needed revision surgery and showed clinical benefit after treatment.
Highlights
Mechanical obstruction of ventriculoperitoneal shunt (VPS) during the first year after shunt implantation is a common complication and is widely described in the literature
Internal cerebrospinal fluid (CSF) diversion is established as the standard therapy, but in cases of poor outcome after ventriculoperitoneal shunting (VPS) or secondary deterioration, it can be difficult to differentiate between non-responders and patients with mechanical shunt dysfunction [1, 14]
Shuntography revealed mechanical complications of the VP shunt in 37% (n = 18) of cases as a cause of clinical deterioration
Summary
Mechanical obstruction of ventriculoperitoneal shunt (VPS) during the first year after shunt implantation is a common complication and is widely described in the literature. Several studies have shown that more than 30% of patients with normal pressure hydrocephalus develop a mechanical complication due to obstruction of the VPS during the first year after shunt implantation [26, 27]. Clinical symptoms as well as assessments of internal and external CSF spaces on cranial imaging can signal shunt dysfunctions These signs are not specific for mechanical complications in the course of the VPS therapy. There are no guidelines for shuntography nor protocols for the procedure or consensus on image interpretation, which severely limits its’ clinical validity This retrospective cohort study aimed to analyze contrast-enhanced shuntography by a quantitative method and to evaluate its’ clinical value for decision-making in patients with suspected VPS dysfunction. This study elaborates on a workflow for indicating, conducting, and interpreting shuntographies
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
