Department of Neurosurgery, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany.
Institute of Radiology and Neuroradiology, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany.
Neuroradiology. 2022 Apr;64(4):745-752. doi: 10.1007/s00234-021-02834-4. Epub 2021 Nov 26.
Mechanical 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).
We 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.
Ninety-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.
Shuntography 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.
在植入分流器后的第一年，脑室-腹腔分流器（VPS）发生机械阻塞是一种常见并发症，在文献中有广泛的描述。在本文中，我们评估了分流造影术在诊断特发性正常压力脑积水（iNPH）患者 VPS 机械并发症中的适用性。
我们回顾性地确定了 20 年来我院 49 例病理性分流造影患者。确定了与程序相关并发症的百分比。
98%（n=48）接受分流造影的患者在检查前显示出引流不足的临床和影像学征象。分流造影术显示 37%（n=18）的 VP 分流机械并发症是导致临床恶化的原因，并在后续的修正手术后发现。在分流造影术中，发现机械性阻塞占 78%（n=14），分流组件断开占 22%（n=4）。在阻塞组中，50%（n=7）的关闭发生在脑室导管中，29%（n=4）发生在 VPS 的远端导管中，21%（n=3）发生在 VPS 的两侧。在分流造影不显影的情况下（63%，n=31），患者接受了对症治疗（32%，n=10）或调整了阀门设置（68%，n=21）。接受手术治疗的患者中有 57%根据 Kiefer 评分至少提高了一个临床评分。
分流造影术可以提供有价值的临床信息，揭示特发性正常压力性脑积水患者植入 VPS 后的机械并发症。VPS 机械并发症的患者需要进行修正手术，治疗后显示出临床获益。
