Ventriculoperitoneal shunt malfunction diagnosis based on substance dilution

Abstract

Objective:Current methods for the diagnosis of ventriculoperitoneal (VP) shunt malfunction lack specific standards; therefore, it may be missed or misdiagnosed. Hence, providing a reliable diagnostic method will help improve the accuracy of preoperative decision-making. Therefore, the aim of the study was to provide a new method for the diagnosis of VP shunt malfunction.Methods:After in vitro testing, we enrolled a total of 12 patients with VP shunt malfunction. Before revision surgery, 0.1 mL of a 5% sodium valproate (SV) solution was injected into the reservoir; 0.1 mL of the cerebrospinal fluid (CSF) was withdrawn 20 minutes later from the reservoir to measure the SV concentration. The process was repeated on the seventh day after surgery and compared with the preoperative results.Results:The mean ± standard deviation preoperative SV concentration in the cerebrospinal fluid was greater than the postoperative concentration (5967.8 ± 1281.3 vs 391.1 ± 184.6 μg/mL, P = .001).Conclusion:The proposed method is a reliable, safe, and relatively simple alternative for the diagnosis of VP shunt malfunction and further provides a reference for treatment.

Permanent Visual Impairment due to Delayed Diagnosis of Shunt Malfunction in Case of Lack of Typical Features of Increased Intracranial Pressure and Unchanged Ventricular Size

“…Squeezing the reservoir or puncturing the V-P shunt reservoir can help in the shunt malfunction diagnosis rapidly and easily [27, 28], which may be helpful in an outpatient or general practitioner situation to refer the patient to the hospital when needed [29]. Furthermore, benefit from the shunt device with valve and reservoir, measuring glucose or sodium valproate solution concentration in the CSF was contributed to verify the flow in shunt [30, 31], and using CSF infusion studies was proved to be valid in cases to unblock occluded hydrocephalus ventricular shunt catheters [32]. But because of the invasiveness and risk of infection or damage to the hardware, they cannot be used as the primary and only method for this aim.…”