Departments of1Neurological Surgery.
2Radiology, and.
J Neurosurg. 2023 Sep 8;140(3):621-626. doi: 10.3171/2023.7.JNS23455. Print 2024 Mar 1.
Radionuclide shuntography (RS) performed using 99mTc-DTPA injected into the reservoir of CSF shunts enables evaluation of CSF flow for suspected shunt malfunctions. The goal of this study was to report the authors' institutional experience with RS and evaluate its utility and associated complications.
The authors retrospectively reviewed all RS studies performed between November 2003 and June 2022. Patients with shunted hydrocephalus who were ≥ 18 years of age were included. Patients undergoing RS for evaluation of Ommaya reservoirs were excluded. Demographics, hydrocephalus etiology, presenting symptoms, study results, subsequent management, complications, and intraoperative diagnoses were recorded. Chi-square tests were reported for categorical variables and standard 2 × 2 contingency methods were used for sensitivity/specificity analysis.
The authors identified 211 RS procedures performed in 142 patients. The mean age at procedure was 55.6 ± 20.9 years (mean ± SD). Normal pressure hydrocephalus was the most common hydrocephalus etiology (37.0%), followed by congenital malformations (26.1%) and idiopathic intracranial hypertension (15.6%). Successful radionuclide injection was achieved in 207 studies (98.1%). Shunt patency was confirmed in 63.8% of successful injections, whereas malfunction was demonstrated in 27.1% and abnormally slow flow was seen in 9.2%. RS studies demonstrating shunt malfunction were more likely to result in subsequent revisions than were studies showing patency (86.6% vs 2.9%; p < 0.0001). The overall sensitivity and specificity of RS for detecting shunt malfunction was 92.3% and 96.2%, respectively. The median follow-up time was 29 months, with 151 cases having ≥ 6 months of follow-up. There were no complications or infections attributable to RS in this cohort.
RS is a useful and safe tool in the workup of shunt malfunction.
使用 99mTc-DTPA 注入脑脊液分流器储液器进行放射性核素分流造影术（RS）可评估疑似分流器故障的脑脊液流动情况。本研究的目的是报告作者机构使用 RS 的经验，并评估其效用和相关并发症。
作者回顾性分析了 2003 年 11 月至 2022 年 6 月间进行的所有 RS 研究。纳入年龄≥18 岁的分流性脑积水患者。排除因评估 Ommaya 储液器而进行 RS 的患者。记录患者的人口统计学、脑积水病因、临床表现、研究结果、后续管理、并发症和术中诊断。对分类变量进行卡方检验，对敏感性/特异性进行标准 2×2 contingency 方法分析。
作者确定了 142 名患者的 211 次 RS 操作。操作时的平均年龄为 55.6±20.9 岁（平均值±标准差）。正常压力脑积水是最常见的脑积水病因（37.0%），其次是先天性畸形（26.1%）和特发性颅内高压（15.6%）。成功进行放射性核素注射的有 207 项研究（98.1%）。在 63.8%的成功注射中证实了分流器通畅，而在 27.1%和 9.2%的研究中显示分流器功能障碍和异常缓慢的流动。显示分流器功能障碍的 RS 研究比显示通畅的研究更有可能导致后续修订（86.6%比 2.9%；p<0.0001）。RS 检测分流器故障的总体敏感性和特异性分别为 92.3%和 96.2%。中位随访时间为 29 个月，151 例患者的随访时间≥6 个月。在这一组中，没有与 RS 相关的并发症或感染。
RS 是分流器故障检查的有用且安全的工具。
