Biochemical Parameters of Cerebrospinal Fluid of Hydrocephalus Patients: Clinical Implications in Predicting Shunt Dysfunction

Abstract The aim of this study is to identify and establish biochemical parameters that can predict shunt blockage or malfunction in patients undergoing ventriculoperitoneal (VP) shunt surgery for hydrocephalus by analyzing cerebrospinal fluid (CSF) obtained during surgery. This retrospective study was conducted among patients with hydrocephalus who underwent VP shunt surgery in the Departments of Neurosurgery at two medical institutions during the periods 2011 to 2014 and 2021 to 2024, respectively. CSF samples were collected during shunt surgery and analyzed. Individual biochemical parameters were studied to identify potential predictive factors for shunt blockage. Each patient was followed-up for a minimum of 6 months to assess shunt malfunction or blockage. Patients with shunt malfunction due to infection or malposition were excluded. A high CSF protein value (>100 mg/dL) was found to be statistically significant in predicting the possibility of shunt blockage during follow-up in patients undergoing VP shunt surgery. The CSF protein level was also inversely proportional to the symptom-free interval following VP shunt placement. The ability to predict shunt malfunction using CSF parameters prior to surgery may help a group of patients avoid unnecessary VP shunt-related complications and help surgeons in appropriate surgical planning and in explaining prognosis.