Shunt Testing In Vivo: Observational Study of Problems with Ventricular Catheter

Abstract

Most shunt obstructions happen at the inlet of the ventricular catheter. Three hundred six infusion studies from 2007 to 2011 were classified as having a typical pattern of either proximal occlusion or patency. We describe different patterns of shunt ventricular obstruction.Solid block: Cerebrospinal fluid (CSF) aspiration was impossible. Baseline pressure was without pulse waveform (respiratory waveform may be visible). A quick increase of pressure to a level compatible with the shunt's setting was recorded in response to infusion. Distal occlusion of the shunt via transcutaneous compression resulted in a rapid increase in pressure to levels above 50 mmHg. This pattern was attributed to a solid ventricular block.Slit ventricles: At baseline, a pattern similar to that of the solid block was observed. After compression, the pressure increases, the pulse waveform appears, and the intracranial pressure is often stabilized at 25-40 mmHg. It is probable that previously slit ventricles were opened during the test.Partial block: In a partial block of the ventricular catheter by an in-growing choroid plexus, the pulse waveform at baseline was observed and CSF aspiration was possible. During infusion, the pressure increased, but the pulse amplitude disappeared. During the increase in the pressure in the shunt prechamber, the connection with the ventricles is disturbed by repositioning of the plexus.Infusion study via the shunt prechamber is able to visualize ventricular obstruction of the hydrocephalus shunt.

Shunt Testing In Vivo: Illustration of Partially Obstructed Ventricular Catheter by In-Growing Choroid Plexus

“…Through one needle Hartmann's fluid is infused and pressure recording is performed through the second needle. In the case of obstruction of the intraventricular catheter, three findings are specific [5]. Firstly, baseline recorded CSF pressure is without any or with very small pulsations synchronised to the heart rate.…”