gms | German Medical Science

Objective: This study was designed to evaluate the relevance of immediate postoperative imaging in ventriculoperitoneal-shunting (VP-shunting) procedures.

Methods: 461 consecutive patients (male 243, female 218; mean age 51.9 years) with VP-shunting procedures who presented during the ten years interval between 2002 and 2012 were included in the study. We reviewed the charts for type of hydrocephalus, type of shunting and of the utilized hardware, postoperative imaging consisting of cranial CT- or MR-scans and x-rays of the entire shunt system, re-operations and valve-adjustments in short-term course, ventricular and peritoneal catheter-malpositioning as well as intracranial bleeding complications.

Results: There were clinically relevant findings in postoperative CT- or MR-scans in 39 patients (8.5%), leading to re-operations in 18 (3.9%) patients and valve-adjustments in 23 (5.0%) patients. Therapeutic relevant findings on x-rays were seen in 11 (2.4%) patients resulting in re-operations in all cases, mostly requiring re-positioning of the peritoneal catheter (6 patients, 1.3%). There was no intracranial bleeding leading to immediate surgical revision. Valve-adjustments due to imaging (CT, MR or x-rays) or clinical findings (high or low intracranial pressure) had been made in a total of 36 patients (7.8%) at discharge.

Conclusion: This study confirms that postoperative cranial CT- or MR-scans are clinically relevant because of therapy-deciding findings in 8.5% of all patients. As radiographical relevant findings mostly occur in x-rays of the peritoneal catheter (1.3%), it should be considered to skip all postoperative x-rays of the VP-shunt except the abdominal x-rays in order to minimize the radiation exposure.