Neuroimaging of ventriculoperitoneal shunt complications in children

Abstract

The ventriculoperitoneal shunt is the mainstay of treatment for hydrocephalus. Despite its widespread use and safety record, it often malfunctions due to complications such as obstruction, breakage, migration and infection. This necessitates a systematic approach to diagnosing the etiology of shunt failure. Any evaluation should begin with an appraisal of the patient's symptoms. In acute malfunction, nausea, vomiting, irritability, seizures, headache, lethargy, coma and stupor are seen. In chronic malfunction, neuropsychological signs, feeding pattern changes, developmental delay, decline in school performance, headaches and increased head size are often seen. The next step in evaluation is a CT scan of the head to evaluate ventricular size. Prior imaging studies should be obtained for comparison; if the ventricles have enlarged over time, shunt malfunction is likely. If there is no such increase or dilation in the first place, other diagnoses are possible. However, "slit ventricle syndrome" should also be considered. When prior imaging is not available, pumping the reservoir, a radionuclide shuntogram, a shunt tap or even surgical exploration are options. The goals of this paper are to provide an algorithm for evaluating shunt malfunction and to illustrate the radiographic findings associated with shunt failure.

Predictors of Ventriculoperitoneal Shunt Failure in Children Undergoing Initial Placement or Revision

“…As an example, intraventricular hemorrhage has been shown to be associated with shunt failure; however, intraventricular hemorrhage was not a predictive factor for shunt failure in the current study [8,19]. In the development of our final multivariable logistic regression models for initial placement and revision, we tested several models based on methods previously outlined [12].…”

Diagnostic Difficulties in Slit Ventricle Syndrome

“…The patients with complete shunt failure often have prolonged periods of suffering and occasional blindness with no evidence of ventricular dilatation [12]. Slit ventricle syndrome is a rare symptomatic condition and adequate treatment may be delayed [13]. Slit ventricle syndrome can be dangerous condition for the patient.…”

Towards diagnostic flow measurement from a catheter tip pressure sensor

“…Short of further investigation, it can be difficult to differentiate these symptoms from that of common pediatric conditions such as urinary tract infection, ottis media or even constipation which can be confused with shunt malfunction [6]. The lack of a universal approach to diagnose shunt failure means that, based on their experiences, neurosurgeons develop their own protocols [7]. In general, a multimodal approach is employed, utilizing imaging, radionuclide studies and ICP studies.…”