Shunt age-related complications in adult patients with suspected shunt dysfunction. A recommended diagnostic workup

Spirig, José Miguel; Frank, M.; Regli, Luca; Stieglitz, Lennart

doi:10.1007/s00701-017-3237-6

Cited by 18 publications

(13 citation statements)

References 10 publications

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“…The predominant symptoms of shunt dysfunction are headache, nausea, vomiting, gait disturbances, visual alterations, neuropsychological deficits, and urinal incontinence [ 6 ]. The risk of shunt dysfunction according to the international literature is from 30% to 50% after 3 years follow-up [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

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Ventriculopleural shunt dysfunction as the first sign of a hidden aneurysmal Subarachnoid Hemorrhage: A case report

Vega-Moreno

Córdoba-Mosqueda

Aguilar-Calderón

et al. 2020

Annals of Medicine and Surgery

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Introduction Subarachnoid Hemorrhage (SAH) is caused by an aneurysmatic origin in 80% of cases. In the adult population, the risk of shunt dysfunction is about 16% in the first year, with proximal mechanical obstruction being the most frequent cause. Case report An 81-year-old man with a history of shunt system placement presented among clinical data of shunt dysfunction. The brain Computed Tomography (CT) showed dilation of the ventricular system, with no other associated injury. The cause of the dysfunction was a SAH determined by a lumbar puncture (LP) study. We performed an angiography reporting 3 aneurysms. Discussion The risk of shunt dysfunction at one year is 40% and at two years, the risk ups to 53% with obstruction of the system and infection being the two principal causes. The usefulness of a lumbar puncture for late detection of SAH lies in the red cells in the Cerebrospinal Fluid (CSF). When the CT is negative and the clinical suspicion remains, the lumbar puncture (LP) continues with higher sensitivity despite is over 12 hours of the onset clinic symptoms. Conclusion This case encourages to follow a rigorous protocol study for patients with multiple shunt dysfunction and chronic hydrocephalus. Also, this case invites to consider a hidden SAH secondary to a vascular pathology as a differential diagnosis for a multiple shunt dysfunction.

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Section: Discussionmentioning

confidence: 99%

“…The risk of shunt dysfunction according to the international literature is from 30% to 50% after 3 years follow-up [ 4 ]. The clinical presentation of our patient led us to suspect a new shunt dysfunction and according to the study protocol reported in the international literature we realized a CT scan and LP to find the etiology [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Ventriculopleural shunt dysfunction as the first sign of a hidden aneurysmal Subarachnoid Hemorrhage: A case report

Vega-Moreno

Córdoba-Mosqueda

Aguilar-Calderón

et al. 2020

Annals of Medicine and Surgery

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“…infection, but overdrainage and mechanical failure continue to pose problems. The diagnosis of shunt malfunction based on a careful clinical history, examination, and investigations such as computed tomography (CT) scanning and plain X-ray shunt series, is not always straightforward [45]. For example, ventricular size may not change in cases with a blocked shunt.…”

Section: This Article Is Part Of the Topical Collection On Csf Circulmentioning

confidence: 99%

Shunt infusion studies: impact on patient outcome, including health economics

et al. 2020

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Objectives The diagnosis of shunt malfunction is often not straightforward. We have explored, in symptomatic shunted patients with hydrocephalus or pseudotumour cerebri syndrome (PTCS), the accuracy of CSF infusion tests in differentiating a functioning shunt from one with possible problems, and the health economic consequences. Methods Participants: hydrocephalus/PTCS patients with infusion tests performed from January 2013 until December 2015. We followed patients up after 6 and 12 months from the test to determine whether they had improved, had persisting symptoms or had required urgent revision. We calculated the total cost savings of revision versus infusion tests and standard protocol of revision and ICP monitoring versus infusion tests. Results Three hundred sixty-five shunt infusion tests had been performed where a shunt prechamber/reservoir was present. For hydrocephalus patients, more than half of the tests (~55%, 155 out of 280) showed no shunt malfunction versus 125 with possible malfunction (ages 4 months to 90 years old). For PTCS patients aged 10 to 77 years old, 47 had possible problems and 38 no indication for shunt malfunction. Overall, > 290 unnecessary revisions were avoided over 3 years' time. Two hundred fiftyeight (> 85%) of those non-surgically managed, remained well, did not deteriorate and did not require surgery. No infections were associated with infusion studies. For Cambridge, the overall savings from avoiding revisions was £945,415 annually. Conclusions Our results provide evidence of the importance of shunt testing in vivo to confirm shunt malfunction. Avoiding unnecessary shunt revisions carries a strong health benefit for patients that also translates to a significant financial benefit for the National Health Service and potentially for other healthcare systems worldwide.

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“…Classical symptoms of shunt malfunction are nonspecific and include headache, lethargy, nausea, and vomiting. [27] When patients present to the ER with symptoms of shunt failure, workup of shunt failure typically begins with brain imaging (computed tomography [CT] scans and shunt X-rays). Unfortunately, shunt failures do not necessarily lead to imaging changes, and hydrocephalus itself does not always indicate shunt failure.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive thermal evaluation for shunt failure in the emergency room

Poole

Sahyouni

et al. 2019

Surgical Neurology International

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Background:Ventriculoperitoneal shunts (VPSs) have been the mainstay of treating hydrocephalus since the 1950s. However, shunts have a reported complication rate reaching nearly 50%. Devices have been developed that utilize noninvasive thermal transcutaneous diffusion technology. These shunt evaluation devices measure temperature gradients to detect shunt cerebrospinal fluid flow. We assessed the utility using a thermal diffusion technique to work up shunt failure in the emergency room (ER).Methods:This was a retrospective case series at a single medical center ER. We included consecutive patients with possible VPS malfunction who were evaluated with a thermal sensor. The time period of data collection included September 2015–April 2018.Results:Eight patients were reviewed, including four males and four females. The average age of reviewed patients was 35.1 (+/− ; 16.5). In our case series, three patients had adequate shunt flow as assessed by the shunt evaluation device, and the decision was made to discharge the patient and follow-up in clinic. In two patients, the flow was diminished, but due to other reassuring signs, the patients were still discharged with follow-up. Two patients were noted to have poor flow and were admitted for shunt revision.Conclusion:It is important to determine whether a malfunction is present and whether an intervention is necessary for patients who present to the emergency department with possible symptoms of shunt failure. A thermal sensor is a fast and noninvasive tool in the evaluation of shunt flow and helps determine whether it is safe to send a patient home or intervene appropriately.

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Shunt age-related complications in adult patients with suspected shunt dysfunction. A recommended diagnostic workup

Abstract: Symptoms of SD remain mostly unspecific. This study showed that the type of SD depends on the time interval from implantation. We propose a workup strategy for patients with SD based on the temporal profile.

Cited by 18 publications

References 10 publications

Ventriculopleural shunt dysfunction as the first sign of a hidden aneurysmal Subarachnoid Hemorrhage: A case report

Ventriculopleural shunt dysfunction as the first sign of a hidden aneurysmal Subarachnoid Hemorrhage: A case report

Shunt infusion studies: impact on patient outcome, including health economics

Noninvasive thermal evaluation for shunt failure in the emergency room

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