Feasibility of B-Ultrasound-Assisted Shunting for Hydrocephalus Patients with Skull Defect Versus Traditional Ventriculoperitoneal Shunting

Summary

During ventriculoperitoneal shunt surgery, the puncture and positioning of the drainage tube are critical, as they significantly affect the outcome. We assessed whether intraoperative B-ultrasound guidance improves ventricular puncture accuracy during ventriculoperitoneal shunting (VPS) in hydrocephalus patients with skull defects.

Abstract

Hydrocephalus combined with a skull defect is a common clinical condition in neurosurgery. It often occurs secondary to decompressive craniectomy after severe craniocerebral injury or cerebral hemorrhage. For such patients, due to the concurrent presence of a skull defect, the puncture and localization of conventional ventriculoperitoneal shunt surgery are somewhat difficult, and the risk of complications is relatively high. This study aimed to evaluate the efficacy of ultrasound-guided ventriculoperitoneal shunting in patients with hydrocephalus associated with skull defects. This study retrospectively analyzed the clinical data of 48 patients with hydrocephalus. Among them, 24 patients had combined skull defects. The observation group underwent ultrasound-assisted ventriculoperitoneal shunting (VPS), whereas the control group underwent traditional VPS. The study compared the success rate of a single puncture during the operation, the operation time, the clinical improvement 2 months after the operation, and the incidence of complications. The results showed that, compared with traditional ventriculoperitoneal shunting, B-ultrasound-assisted shunting provided real-time assessment. It not only causes less trauma and significantly improves puncture accuracy during the operation but also does not prolong the operation time. Moreover, it can allow real-time visualization of the catheter trajectory in patients with skull defects and postoperative hydrocephalus. The complication and efficacy rates of this method did not differ significantly between groups; the numerical differences warrant confirmation in larger prospective studies, improve the reliability of intraoperative operations, and have significant clinical promotion value in treating such patients.

Introduction

Hydrocephalus is a neurological disorder resulting from abnormal production, impaired circulation, or impaired absorption of cerebrospinal fluid. This results in cerebrospinal fluid accumulation within the ventricles and the cranial cavity, causing increased intracranial pressure^1,2. Typically, the condition involves enlarged ventricles, interstitial brain edema, compression of brain tissue, and severe clinical manifestations³. Surgical treatment is often required.

Additionally, certain individuals with hydrocephalus have undergone decompressive craniectomy

Protocol

The study protocol was approved by the Ethics Committee of Nantong First People's Hospital, Southeast University (No. 2025KT029), and informed consent was obtained from all participants.

Patient characteristics
This study included 48 adult patients with hydrocephalus. Among them, 24 patients with skull defects (observation group) underwent ventriculoperitoneal shunt surgery assisted by B-ultrasound between January 2022 and December 2024. The other 24 patients with repaired skull defects (the control group) received traditional ventriculoperitoneal shunt treatment from January 2021 to December 2023.

Results

The two groups showed no statistically significant differences in sex, age, severity of preoperative hydrocephalus, or skull defect (P > 0.05; Table 1). All 24 patients in the observation group underwent successful initial punctures. Postoperative head CT scans confirmed precise shunt tube placement in the frontal angle of the lateral ventricle, on the day after surgery, with no evidence of puncture tract complications or intraventricular hemorrhage. In the control group, six patients require.......

Discussion

Ventriculoperitoneal shunting (VPS) has been a routine method for treating communicating hydrocephalus^2,6. Clinically, hydrocephalus manifests through impaired consciousness, worsening of symptoms after initial improvement, or persistent worsening, specifically causing deepening of coma, dizziness, headaches, nausea, vomiting, slowed reactions, and progressive swelling at the cranial decompression site, accompanied by gradually increasing and stiffening tension i.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Codman Shunt	Johnson & Johnson, United States	82-6100
Drill	Beijing Honghu Medical Devices Co., LTD	HK-208
iodophor disinfectant	Taizhou Tiancheng Medical Supplies Co., LTD	PVI-500
Mastoid spreader	Shanghai Jinzhong Medical Devices Co., LTD	JZ-312
Portable Mindray Z50S B-ultrasound	Mindray Company, China	Z50S
Sterile gauze	Nantong Meilihe Medical Devices Co., LTD	MLH-GZ-01
Suture	Johnson & Johnson, United States	VP-922
SPSS26.0	version 26.0, IBM Corp., Armonk, NY, USA	https://www.ibm.com/support/pages/ibm-spss-statistics-26-documentation	Statistical software