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Cerebrospinal Fluid Lumbar Tapping Utilization for Suspected Ventriculoperitoneal Shunt Under-Drainage Malfunctions
Article en En | WPRIM | ID: wpr-56571
Biblioteca responsable: WPRO
ABSTRACT
OBJECTIVE: The diagnosis of shunt malfunction can be challenging since neuroimaging results are not always correlated with clinical outcomes. The purpose of this study was to evaluate the efficacy of a simple, minimally invasive cerebrospinal fluid (CSF) lumbar tapping test that predicts shunt under-drainage in hydrocephalus patients. METHODS: We retrospectively reviewed the clinical and radiological features of 48 patients who underwent routine CSF lumbar tapping after ventriculoperitoneal shunt (VPS) operation using a programmable shunting device. We compared shunt valve opening pressure and CSF lumbar tapping pressure to check under-drainage. RESULTS: The mean pressure difference between valve opening pressure and CSF lumbar tapping pressure of all patients were 2.21±24.57 mmH₂O. The frequency of CSF lumbar tapping was 2.06±1.26 times. Eighty five times lumbar tapping of 41 patients showed that their VPS function was normal which was consistent with clinical improvement and decreased ventricle size on computed tomography scan. The mean pressure difference in these patients was −3.69±19.20 mmH₂O. The mean frequency of CSF lumbar tapping was 2.07±1.25 times. Fourteen cases of 10 patients revealed suspected VPS malfunction which were consistent with radiological results and clinical symptoms, defined as changes in ventricle size and no clinical improvement. The mean pressure difference was 38.07±23.58 mmH₂O. The mean frequency of CSF lumbar tapping was 1.44±1.01 times. Pressure difference greater than 35 mmH₂O was shown in 2.35% of the normal VPS function group (2 of 85) whereas it was shown in 64.29% of the suspected VPS malfunction group (9 of 14). The difference was statistically significant (p=0.000001). Among 10 patients with under-drainage, 5 patients underwent shunt revision. The causes of the shunt malfunction included 3 cases of proximal occlusion and 2 cases of distal obstruction and valve malfunction. CONCLUSION: Under-drainage of CSF should be suspected if CSF lumbar tapping pressure is 35 mmH₂O higher than the valve opening pressure and shunt malfunction evaluation or adjustment of the valve opening pressure should be made.
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Texto completo: 1 Índice: WPRIM Asunto principal: Líquido Cefalorraquídeo / Estudios Retrospectivos / Derivación Ventriculoperitoneal / Diagnóstico / Neuroimagen / Hidrocefalia Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies Límite: Humans Idioma: En Revista: Journal of Korean Neurosurgical Society Año: 2017 Tipo del documento: Article
Texto completo: 1 Índice: WPRIM Asunto principal: Líquido Cefalorraquídeo / Estudios Retrospectivos / Derivación Ventriculoperitoneal / Diagnóstico / Neuroimagen / Hidrocefalia Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies Límite: Humans Idioma: En Revista: Journal of Korean Neurosurgical Society Año: 2017 Tipo del documento: Article