The Role of Limited Head Computed Tomography in the Evaluation of Pediatric Ventriculoperitoneal Shunt Malfunction

Park, Daniel B.; Hill, Jeanne G.; Thacker, Paul G.; Rumboldt, Zoran; Huda, Walter; Ashley, Bryan; Hulsey, Thomas C.; Russell, W. Scott

doi:10.1097/pec.0000000000000760

Cited by 17 publications

(11 citation statements)

References 18 publications

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“…36 Limited cranial CT scan techniques to decrease exposure in patients with a ventriculoperitoneal shunt have also been recently proposed. 39 Therefore, in our model, rather than eliminate the risk entirely, we decreased the risk of radiation-induced cancer to 7 per 10 000 as the lower limit in our sensitivity analysis.…”

Section: Discussionmentioning

confidence: 99%

“…In our model, we assigned values (or utilities) to health outcomes using a standard Health Utilities Index scale ranging from 0 (death) to 1 (baseline health, assumed as perfect health for this hypothetical population). The Health Utilities Index is a 15-item questionnaire designed to ask the minimum number of questions required to classify a subject's 10%-50% Sensitivity of CT 32 -37 66% 53%-88% Specificity of CT 32 -37 87% 76%-96% Sensitivity of fsMRI 32,36,38 58% 51%-78% Specificity of fsMRI 32,36,38 93% 89%-98% Sensitivity of ONSD 16 -19 75% 61%-83% Specificity of ONSD 16 -19 32% 22%-38% Sensitivity of SS 33 -35, 37 19% 4%-30% Specificity of SS 33 -35, 37 95% 91%-98% Probability of death and/or missed diagnosis a 0.1% (1:1000) 0.01%-0.2% Probability of radiation-induced malignancy 9,11,21,31,39 0.22% 0.07%-0.6%…”

Section: Utilitiesmentioning

confidence: 99%

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Imaging Strategies for Suspected Acute Cranial Shunt Failure: A Cost-Effectiveness Analysis

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Section: Utilitiesmentioning

confidence: 99%

Imaging Strategies for Suspected Acute Cranial Shunt Failure: A Cost-Effectiveness Analysis

et al. 2017

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“…A pediatric head CT scan is often used to assess the increase in ventricular size, an indication of VPS malfunction. 17 An alternative method for achieving this is MRI, which can provide acceptable images for diagnosing VPS malfunction in pediatric patients. 18 Margaret et al suggested that MRI scans should be used more often in the diagnosis of VPS malfunction, as they do not require radiation exposure, unlike CT scans.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Pediatric Imaging Modalities Practices of Radiologists and Technologists: A Survey-Based Study

Tajaldeen¹,

Kheiralla²,

Al‐Ghamdi

et al. 2022

JMDH

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Introduction Radiation protection for pediatric patients is the main concern in pediatric computed tomography (CT) due to their sensitive organs, such as the brain and the thyroid glands. Accordingly, an optimization of pediatric CT practices is vital to minimize the radiation dose for this population. Aim To assess the pediatric CT practices of radiologists and technologists in a CT unit. Materials and Methods The study was conducted among 26 hospitals, located in various regions in Saudi Arabia. A total of 200 hard copies of the questionnaire were distributed manually and were collected for analysis. In total, 117 completed surveys were gathered from technologies, while 49 were gathered from radiologists. Results In the case of infants with hydrocephalus, 65% of the radiologists ordered an ultrasound (US), 24% ordered a head CT scan, and 10% ordered a magnetic resonance imaging (MRI) and general X-ray for diagnosis. For pediatric patients complaining of persistent headache, 59% and 27% of the radiologists recommended CT and MRI, respectively, for diagnosis. Conclusion Most of the radiologists utilize CT head scan to diagnose persistent headache (by 59%) and ventriculoperitoneal shunt (VPS) malfunction (by 41%) in pediatric patients compared with the other modalities. The use of CT can increase the risk of later malignancy among pediatric patients due to radiation exposure. Alternative imaging modalities such as US and MRI (non-ionized radiation) should be considered to reduce the ionizing radiation hazards and optimize the current practices of radiologists. Most of the technologists follow radiation protection protocols in this study as 63% of the technologists used lead apron for pediatric patient’s protection. Radiation awareness training for the technologists could improve the knowledge about the benefits of using lead apron and reduce the radiation risks in pediatric patients.

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“…The VPS is the most commonly used shunt in selected patients with hydrocephalus. 1 , 4 , 5 The VPS has been modified over the years. However, the current VPS comprises 3 parts: proximal (ventricular) catheter, pressure-sensitive valve with a reservoir, and distal (peritoneal) catheter.…”

Section: Discussionmentioning

confidence: 99%

“…A pressure-sensitive valve could be fixed or adjustable. 5 Although VP shunting is well known as one of the oldest procedures in neurosurgery practice, complication rates of VP shunting are 25%–60%. 1 …”

Section: Discussionmentioning

confidence: 99%

Shunt Valve Rupture in Ventriculoperitoneal Shunt Failure

et al. 2021

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Background Shunt complications are common despite advances in surgical techniques and shunting technology. Proximal and/or distal catheter malfunctions are detected in pediatric and adult patients. However, valve dysfunction is rare in such cases. Case Description A 24-year-old woman presented with a history of ventriculostomy and ventriculoperitoneal shunt (VPS) secondary to hydrocephalus concomitant with Dandy-Walker syndrome. She has had undulant headache and vision loss episodes in both eyes for 15 days. Her VPS valve was normal when manually checked, and the VPS was observed as intact on x-ray and computed tomography scan. She had high-grade papilledema in both eyes with an optical coherence tomography scan value of 55/99. Lumbar puncture was performed. Cerebrospinal fluid opening pressure was 560 mm H 2 O under sedation. VPS exploration surgery was performed. There was a tiny defect over the shunt valve from where clear cerebrospinal fluid was leaking. We revised the old VPS valve with a new valve of 1.5 regular pressure. Her vision improved shortly after the surgery. Conclusions This case is a very rare example of shunt valve dysfunction that required further investigation and a new valve replacement even though the preoperative imaging was normal.

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The Role of Limited Head Computed Tomography in the Evaluation of Pediatric Ventriculoperitoneal Shunt Malfunction

Cited by 17 publications

References 18 publications

Imaging Strategies for Suspected Acute Cranial Shunt Failure: A Cost-Effectiveness Analysis

Imaging Strategies for Suspected Acute Cranial Shunt Failure: A Cost-Effectiveness Analysis

Evaluation of Pediatric Imaging Modalities Practices of Radiologists and Technologists: A Survey-Based Study

Shunt Valve Rupture in Ventriculoperitoneal Shunt Failure

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