Shunt failure remains a challenging diagnosis for neurosurgeons, particularly when patient symptoms suggest shunt malfunction but radiographic evidence is lacking. In such situations, shuntograms are sometimes employed to guide medical decision-making. In this study, the authors aimed to investigate the utility of shuntograms in aiding patient management, particularly in terms of a negative result.

This retrospective single-institution series comprises patients who underwent a shuntogram procedure to evaluate shunt patency over a roughly 6-year period. The medical records of patients were reviewed to determine the findings of the shuntogram procedure, the type of obstruction, and whether a subsequent operation for a shunt revision took place either within 30 days or up to 1 year after the procedure. Statistical analysis was completed by calculating the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of the shuntogram as compared with the revision surgery.

Of the 98 patients who underwent a shuntogram, 95 patients were included in the statistical analysis. A ventriculoperitoneal shunt was assessed in 81% of patients (77/95). The PPV of the procedure was 100%. The NPV for predicting a subsequent shunt revision within 30 days was 68.3% (false-negative rate of 31.7%) or within 365 days was 61.2% (false-negative rate of 38.8%). The sensitivity and specificity of the shuntogram were 55.8% and 100% within 30 days and 51.9% and 100% within 365 days, respectively. The most common intervention at the time of surgery following a negative shuntogram was a valve replacement in 38.5% of patients (10/26).

With an NPV of 68.3% for predicting revision within 30 days in our series of 95 patients, shuntograms remained a useful tool in the clinical decision-making process when evaluating potential shunt failure.

对于神经外科医生来说，分流器故障仍然是一个具有挑战性的诊断，特别是当患者症状表明分流器故障但缺乏放射学证据时。在这种情况下，有时会使用分流图来指导医疗决策。在这项研究中，作者旨在调查分流图在帮助患者管理方面的效用，尤其是在阴性结果方面。

这个回顾性的单机构系列包括在大约 6 年的时间里接受分流图程序以评估分流通畅性的患者。审查患者的医疗记录以确定分流图检查的结果、阻塞的类型以及分流修正的后续手术是否在手术后 30 天内或最多 1 年内进行。通过计算与翻修手术相比分流图的敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV）来完成统计分析。

在接受分流图检查的 98 名患者中，95 名患者被纳入统计分析。81% 的患者 (77/95) 评估了脑室腹腔分流术。手术的PPV为100%。用于预测 30 天内后续分流修正的 NPV 为 68.3%（假阴性率为 31.7%）或 365 天内为 61.2%（假阴性率为 38.8%）。分流图的敏感性和特异性在 30 天内分别为 55.8% 和 100%，在 365 天内分别为 51.9% 和 100%。38.5% (10/26) 的患者分流图阴性后手术时最常见的干预是瓣膜置换术。

在我们的 95 名患者系列中预测 30 天内翻修的 NPV 为 68.3%，在评估潜在的分流失败时，分流图仍然是临床决策过程中的有用工具。