Chew Zakir, Loh Daniel, Leong Adriel, Loi Hoi Yin, Yeo Tseng Tsai
Department of Surgery, Division of Neurosurgery, National University Hospital Singapore, Singapore, SGP.
Department of Diagnostic Imaging, National University Hospital Singapore, Singapore, SGP.
Cureus. 2025 Apr 29;17(4):e83184. doi: 10.7759/cureus.83184. eCollection 2025 Apr.
Although cerebrospinal fluid (CSF) diversion through ventriculoperitoneal shunt insertion is a conventional treatment for hydrocephalus, shunt malfunction is a common complication, making its diagnosis critical. We report a patient with a background of congenital hydrocephalus and an in situ ventriculoperitoneal shunt (VPS) exhibiting worsening papilledema with raised lumbar puncture opening pressures, indicating a possible VPS malfunction. A review of the current diagnostic methods for VPS malfunction, focusing on radionuclide scintigraphy, was conducted in this case review. VPS radionuclide scintigraphy was successfully performed in our patient using intrathecal administration of Tc-99m diethylene-triamine-penta-acetic acid (DTPA) into the CSF shunt reservoir, facilitating tracer visualization. A review of the patient's case notes and subsequent literature review identified several methods for diagnosing VPS malfunction to determine the correct shunt malfunction segment and respective corrective measures. VPS radionuclide scintigraphy in our patient confirmed a patent distal peritoneal catheter, although a transient proximal ventricular catheter blockage and malfunction remained a possibility. The literature review highlighted successful worldwide applications of substance dilution, thermal transfer, ultrasound, and Doppler techniques for diagnosing VPS malfunction with radionuclide shunt scintigraphy. Evaluating VPS function comprises various methods and is significantly important to prevent adverse consequences for the patient, allowing prompt revision surgery directed at the site of obstruction or malfunction. Hence, VPS malfunction diagnosis is vital for leading appropriate corrective measures, with radionuclide shunt scintigraphy functioning as a non-invasive method.
尽管通过脑室腹腔分流术进行脑脊液（CSF）引流是治疗脑积水的传统方法，但分流器故障是一种常见并发症，因此其诊断至关重要。我们报告了一名患有先天性脑积水且原位脑室腹腔分流术（VPS）的患者，该患者出现视乳头水肿加重且腰穿初压升高，提示可能存在VPS故障。在本病例回顾中，对当前VPS故障的诊断方法进行了综述，重点是放射性核素闪烁扫描。我们的患者通过向脑脊液分流器储液器鞘内注射Tc-99m二乙三胺五乙酸（DTPA）成功进行了VPS放射性核素闪烁扫描，便于示踪剂显影。回顾患者的病历记录并随后进行文献综述，确定了几种诊断VPS故障的方法，以确定正确的分流器故障段及相应的纠正措施。我们患者的VPS放射性核素闪烁扫描证实远端腹膜导管通畅，尽管近端脑室导管仍有可能存在短暂堵塞和故障。文献综述强调了物质稀释、热传递、超声和多普勒技术在全球范围内成功应用于通过放射性核素分流闪烁扫描诊断VPS故障。评估VPS功能包括多种方法，对于防止给患者带来不良后果非常重要，可使针对梗阻或故障部位的及时翻修手术得以进行。因此，VPS故障诊断对于采取适当的纠正措施至关重要，放射性核素分流闪烁扫描作为一种非侵入性方法发挥着作用。
