Vigo-Prieto Juan, Vicenty Juan, De Jesus Orlando, Maldonado-Pérez Ashlie, Carrasquillo Gloria, Davila Martinez Roberto
Neurological Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI.
Neurosurgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI.
Cureus. 2025 Jul 2;17(7):e87154. doi: 10.7759/cureus.87154. eCollection 2025 Jul.
For patients of all ages, symptoms of headache, nausea, vomiting, or altered mental status due to shunt malfunction are frequent causes of visits to the emergency department. However, in shunted patients, those symptoms can also be attributed to other conditions. In this study, we evaluated the use of cerebrospinal fluid density measurements on the head CT scans as a potential radiologic indicator of shunt malfunction. The study aimed to evaluate whether lower ventricular cerebrospinal fluid Hounsfield unit values on pre-operative CT scans correlate with shunt malfunction, as reflected by an increase in Hounsfield unit following revision.
The University of Puerto Rico Neurosurgery Database was scrutinized to identify patients diagnosed with hydrocephalus who underwent a ventricular shunt revision from August 2021 to August 2024. For each patient, we measured the mean ventricular cerebrospinal fluid Hounsfield unit value within the atrium of the lateral ventricles on the CT scan axial view before and after the shunt revision. The correlation between the preoperative group and the postoperative group was assessed using the non-parametric Spearman's rank correlation coefficient.
The cohort consisted of 34 patients, aged one to 71 years, with a median age of 35.5 years (interquartile range, 26-45 years). Eighteen percent of the cohort was under 18 years of age. There were 17 females and 17 males. The mean ventricular cerebrospinal fluid pre-operative Hounsfield unit value was 5.2 (range: -1 to 12), and the postoperative mean Hounsfield unit value was 6.0 (range: -2 to 13). The difference in Hounsfield unit values between the preoperative and postoperative patients with shunt malfunction who underwent shunt revision was significant (p-value = 0.045).
Our study findings suggest that lower ventricular cerebrospinal fluid Hounsfield unit values may correlate with shunt malfunction. When a prior head CT scan is available, Hounsfield unit comparison can serve as an adjunctive diagnostic tool to guide clinical decision-making.
对于各年龄段患者而言，因分流器故障导致的头痛、恶心、呕吐或精神状态改变是其频繁前往急诊科就诊的常见原因。然而，在接受分流手术的患者中，这些症状也可能归因于其他病症。在本研究中，我们评估了头部CT扫描中脑脊液密度测量作为分流器故障潜在影像学指标的应用情况。该研究旨在评估术前CT扫描中较低的脑室脑脊液亨氏单位值是否与分流器故障相关，这可通过翻修术后亨氏单位值的增加来体现。
对波多黎各大学神经外科数据库进行审查，以识别出2021年8月至2024年8月期间接受脑室分流翻修手术的脑积水患者。对于每位患者，我们在分流翻修手术前后的CT扫描轴位视图上测量侧脑室心房内的平均脑室脑脊液亨氏单位值。使用非参数斯皮尔曼等级相关系数评估术前组和术后组之间的相关性。
该队列包括34名患者，年龄在1岁至71岁之间，中位年龄为35.5岁（四分位间距为26 - 45岁）。该队列中18%的患者年龄在18岁以下。有17名女性和17名男性。术前脑室脑脊液平均亨氏单位值为5.2（范围：-1至12），术后平均亨氏单位值为6.0（范围：-2至13）。接受分流翻修手术的术前和术后有分流器故障的患者之间的亨氏单位值差异具有统计学意义（p值 = 0.045）。
我们的研究结果表明，较低的脑室脑脊液亨氏单位值可能与分流器故障相关。当有先前的头部CT扫描可用时，亨氏单位比较可作为辅助诊断工具来指导临床决策。
