Analysis of the Effect of Lumboperitoneal Shunt and the Prognostic Factors in Communicating Hydrocephalus.

Chai, Byung Moon; Kim, Tae Young; Han, Byung Gab; Kim, Jong Moon

Original Article

Journal of Korean Neurosurgical Society 1995;24(9): 1007-1014.

Byung Moon Chai, Tae Young Kim, Byung Gab Han, Jong Moon Kim

Department of Neurosurgery, School of Medicine, Wonkwang University, Iri, Korea.

ABSTRACT

The effect of lumboperitoneal(LP) shunt and the prognostic factors of 40 cases of communicating hydrocephalus confirmed by brain computerized tomography(CT) and/or magnetic resonance imaging(MRI) and radioisotope cisternography(RI) were analyzed. Possible prognostic factors such as disease entity, CT or MRI findings, and the type of radioisotope cisternography were compared to improvement of clinical status after LP shunt. The etiology of communicating hydrocephalus in the analyzed 40 cases included trauma in 13 cases(32.5%), subarachnoid hemorrhage(SAH) in 12 cases(30%), intracerebral hemorrhage(ICH) in 10 cases(25%), and idiopathic in 5 cases(12.5%). An overall clinical improvement after LP shunt was seen in 22 cases(55%). However, in 17 cases of SAH and idiopathic group, improvement after LP shunt was seen in 13 cases(75%), indicating that LP shunt is more effective in SAH/idiopathic group than trauma/ICH group(p<0.05). Many findings of brain CT/MRI such as Evan's index, periventricular low density, 3rd ventricular width, obliteration of cerebral sulci, rounding of frontal horn, and cortical atrophy were analyzed as prognostic factors. Except for the absence of cortical atrophy(p<0.05), none of the factors were related to the patient's outcome. The type of abnormal RI cisternography findings(Typ I, II, III) also did not show any relationship with the effectiveness of LP shunt. These findings suggest that SAH/idiopathic group were more favorable candidates for LP shunt than trauma/ICH group, and that there are no reliable brain CT/MRI findings indicating a good prognosis after LP shunt except for the absence of cortical atrophy. RI cisternography findings are also not a reliable diagnostic tool in evaluating the indication of LP shunt in communicating hydrocephalus.

Key Words: Communicating hydrocephalus; Lumboperitoneal shunt; Radioisotope cisternography; Cortical atrophy