Journal of Korean Neurosurgical Society

  • 제60권1호
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  • Pages.1-7
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  • 2017
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Cerebrospinal Fluid Lumbar Tapping Utilization for Suspected Ventriculoperitoneal Shunt Under-Drainage Malfunctions

  • Lee, Jong-Beom (Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine (Nursing), The Catholic University of Korea) ;
  • Ahn, Ho-Young (Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine (Nursing), The Catholic University of Korea) ;
  • Lee, Hong-Jae (Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine (Nursing), The Catholic University of Korea) ;
  • Yang, Ji-Ho (Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine (Nursing), The Catholic University of Korea) ;
  • Yi, Jin-Seok (Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine (Nursing), The Catholic University of Korea) ;
  • Lee, Il-Woo (Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine (Nursing), The Catholic University of Korea)
  • 투고 : 2016.04.04
  • 심사 : 2016.07.28
  • 발행 : 2017.01.01
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초록

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 $2.21{\pm}24.57mmH_2O$. The frequency of CSF lumbar tapping was $2.06{\pm}1.26times$. 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 $-3.69{\pm}19.20mmH_2O$. The mean frequency of CSF lumbar tapping was $2.07{\pm}1.25times$. 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 $38.07{\pm}23.58mmH_2O$. The mean frequency of CSF lumbar tapping was $1.44{\pm}1.01times$. Pressure difference greater than $35mmH_2O$ 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 $35mmH_2O$ higher than the valve opening pressure and shunt malfunction evaluation or adjustment of the valve opening pressure should be made.

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참고문헌

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피인용 문헌

  1. Noninvasive Thermal Evaluation of Ventriculoperitoneal Shunt Patency and Cerebrospinal Fluid Flow Using a Flow Enhancing Device vol.85, pp.2, 2019, https://doi.org/10.1093/neuros/nyy246
  2. Diagnostic Accuracy of Non-Invasive Thermal Evaluation of Ventriculoperitoneal Shunt Flow in Shunt Malfunction: A Prospective, Multi-Site, Operator-Blinded Study vol.87, pp.5, 2017, https://doi.org/10.1093/neuros/nyaa128