Cerebrospinal Fluid Lumbar Tapping Utilization for Suspected Ventriculoperitoneal Shunt Under-Drainage Malfunctions

Lee, Jong-Beom; Ahn, Ho-Young; Lee, Hong-Jae; Yang, Ji-Ho; Yi, Jin-Seok; Lee, Il-Woo

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자료유형: 학술저널

저자정보: 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)

저널정보: 대한신경외과학회 대한신경외과학회지 대한신경외과학회지 제60권 제1호

발행연도: 2017.1

수록면: 1 - 7 (7page)

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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.

#Hydrocephalus #Shunt malfunction #Ventroculoperitoneal shunt #Under-drainage #Lumbar tapping

참고문헌 (17)

참고문헌 신청

Boon JM / 2004 / Lumbar puncture : anatomical review of a clinical skill / Clin Anat 17:544~553

Browd SR / 2006 / Failure of cerebrospinal fluid shunts : part II : overdrainage, loculation, and abdominal complications / Pediatr Neurol 34:171~176

Hakim S / 1973 / Hydraulic and mechanical mis-matching of valve shunts used in the treatment of hydrocephalus : the need for a servo-valve shunt / Dev Med Child Neurol 15:646~653

Han YM / 1999 / A clinical analysis of the ventriculoperitoneal shunt with programmable shunt divice / J Korean Neurosurg Soc 28:75~81

Hebb AO / 2001 / Idiopathic normal pressure hydrocephalus : a systematic review of diagnosis and outcome / Neurosurgery 49:1166~1184

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