Limitations in the Diagnosis of Valvular Dysfunction Using the Rickham Reservoir

Sacher, PM; Hirsig, J.; Boltshauser, Eugen

doi:10.1055/s-2008-1063260

Cited by 1 publication

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“…Rickham’s reservoir has been implanted at a frontal site in addition to the placement of the shunt in patients with hydrocephalus to facilitate the diagnosis of shunt malfunction and at the same time decompress the ventricle in the event of acute shunt malfunction [2, 3, 4]. Direct tap of the reservoir has been effectively used to estimate the pressure and hence the shunt functions.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Shunt Malfunction Using Shunt Site Reservoir

Sood

Canady

Ham³

2000

Pediatr Neurosurg

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Objective: To determine the usefulness of a separate reservoir placed at the site of the shunt in evaluation of shunt malfunction. Methods and Materials: A ventricular catheter was placed alongside the proximal catheter of the shunt and connected to a subgaleal reservoir in 17 patients, in 9 a double-lumen catheter with integrated reservoir and in 13 patients a dual catheter with a double-port reservoir was used. At presentation of suspected shunt malfunction, a standard shunt function evaluation using shunt tap, CT scan or shunt injection was performed, and subsequently, the pressure from the tap of the reservoir was obtained. Results: Thirty-three patients presented with symptoms of malfunction at an interval of 2.3 ± 3 months (range 2–429 days). The pretest probability of shunt malfunction in this population was 73%. Posttest probability of shunt malfunction was 82.5% with standard evaluation and improved to 100% by the separate reservoir tap pressure measurement. In 4 patients in whom the shunt tap was dry, shunt infection was diagnosed prior to revision using CSF obtained at the reservoir tap. In 5 patients with proximal malfunction and bradycardia, the reservoir tap allowed early ventricular decompression. Conclusion: This study shows that a reservoir placed at the site of the shunt remains patient even when the shunt malfunctions, suggesting that flow rather than catheter position is important in proximal malfunction. It is superior to shunt tap for detection of shunt malfunction and infection, and it allows early ventricular decompression in a sick patient awaiting surgery for shunt revision.

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Section: Discussionmentioning

confidence: 99%