Value of computerized shunt infusion study in assessment of pediatric hydrocephalus shunt function-a two center cross-sectional study.
Hydrocephalus
Intracranial pressure
Pediatric neurosurgery
Shunt dysfunction
Shunt infusion study
Journal
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
ISSN: 1433-0350
Titre abrégé: Childs Nerv Syst
Pays: Germany
ID NLM: 8503227
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
23
05
2019
accepted:
17
06
2019
pubmed:
3
8
2019
medline:
22
6
2021
entrez:
3
8
2019
Statut:
ppublish
Résumé
Hydrocephalus shunt malfunction can-also in children-occur insidiously without clear symptoms of raised intracranial pressure (ICP) or changes in ventricular size, imposing a diagnostic challenge. Computerized shunt infusion studies enable quantitative shunt function assessment. We report on feasibility and results of this technique in children in a two center cross-sectional study. Shunt infusion study (SIS) is performed with two needles inserted into a pre-chamber for ICP recording and CSF infusion. After baseline ICP recording, constant rate infusion is started until a new ICP plateau (ICPpl) is reached. Dedicated software containing the shunt's resistance characteristics calculates ICP and its amplitude outflow resistance and critical shunt pressure (CSP). Overall, 203 SIS were performed in 166 children. Shunts were defined as functional if ICPpl was <CSP and obstructed if ICPpl was > 5 mmHg above CSP and borderline in between. Forty-one shunts (20.2%) were found obstructed, 26 (12.8%) had borderline characteristics, and 136 (67%) were functional. Baseline ICP in obstructed shunts was significantly above shunt operating pressure. CSF outflow resistance (R SIS is a feasible, reliable, and radiation-free technique for quantitative shunt assessment to rule out or prove shunt malfunction. Dedicated software containing shunt hydrodynamic characteristics is necessary and small children may need short-term sedation. Due to the clinical and inherent economic advantages, SIS should be more frequently used in pediatric neurosurgery.
Sections du résumé
BACKGROUND
Hydrocephalus shunt malfunction can-also in children-occur insidiously without clear symptoms of raised intracranial pressure (ICP) or changes in ventricular size, imposing a diagnostic challenge. Computerized shunt infusion studies enable quantitative shunt function assessment. We report on feasibility and results of this technique in children in a two center cross-sectional study.
MATERIAL AND METHODS
Shunt infusion study (SIS) is performed with two needles inserted into a pre-chamber for ICP recording and CSF infusion. After baseline ICP recording, constant rate infusion is started until a new ICP plateau (ICPpl) is reached. Dedicated software containing the shunt's resistance characteristics calculates ICP and its amplitude outflow resistance and critical shunt pressure (CSP). Overall, 203 SIS were performed in 166 children. Shunts were defined as functional if ICPpl was <CSP and obstructed if ICPpl was > 5 mmHg above CSP and borderline in between.
RESULTS
Forty-one shunts (20.2%) were found obstructed, 26 (12.8%) had borderline characteristics, and 136 (67%) were functional. Baseline ICP in obstructed shunts was significantly above shunt operating pressure. CSF outflow resistance (R
CONCLUSION
SIS is a feasible, reliable, and radiation-free technique for quantitative shunt assessment to rule out or prove shunt malfunction. Dedicated software containing shunt hydrodynamic characteristics is necessary and small children may need short-term sedation. Due to the clinical and inherent economic advantages, SIS should be more frequently used in pediatric neurosurgery.
Identifiants
pubmed: 31372736
doi: 10.1007/s00381-019-04264-3
pii: 10.1007/s00381-019-04264-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
59-71Références
J Neurosurg. 2016 Feb;124(2):342-9
pubmed: 26295913
Childs Nerv Syst. 2018 Oct;34(10):1915-1924
pubmed: 29978253
J Neurol Neurosurg Psychiatry. 2004 Jun;75(6):813-21
pubmed: 15145991
Neurosurg Focus. 2016 Nov;41(5):E6
pubmed: 27798984
Physiol Meas. 2005 Dec;26(6):1137-48
pubmed: 16311460
Neurosurgery. 2011 Jan;68(1):198-205; discussion 205
pubmed: 21099708
Physiol Meas. 2004 Oct;25(5):R51-76
pubmed: 15535175
Acta Neurochir Suppl. 2012;114:75-9
pubmed: 22327667
J Nucl Med. 1973 Sep;14(9):683-6
pubmed: 4724337
J Neurosurg. 1992 Jul;77(1):15-9
pubmed: 1607958
Radiographics. 1998 May-Jun;18(3):635-51
pubmed: 9599388
Acta Neurochir Suppl. 2005;95:247-51
pubmed: 16463858
J Neurosurg Pediatr. 2015 Dec;16(6):633-41
pubmed: 26359766
Acta Neurol Scand. 2011 Aug;124(2):85-98
pubmed: 21208195
Turk J Med Sci. 2014;44(3):393-6
pubmed: 25558639
Br J Hosp Med (Lond). 2007 Dec;68(12):651-5
pubmed: 18186399
BMJ Case Rep. 2018 May 16;2018:
pubmed: 29769186
J Neurosurg. 1978 Mar;48(3):332-44
pubmed: 632857
Neurosurgery. 2017 Mar 1;80(3):439-447
pubmed: 28362957
J Neurosurg. 2014 Mar;120(3):697-707
pubmed: 24405071
Acta Neurochir Suppl. 2008;102:145-51
pubmed: 19388307
Pediatr Emerg Care. 2015 Jun;31(6):435-40; quiz 441-3
pubmed: 26035499
World J Nucl Med. 2014 May;13(2):75-84
pubmed: 25191120
J Neurosurg Pediatr. 2014 Nov;14 Suppl 1:30-4
pubmed: 25988780
J Neurosurg Pediatr. 2014 Nov;14 Suppl 1:60-71
pubmed: 25988784
Acta Neurol Scand. 2016 Sep;134(3):168-80
pubmed: 26666840
J Pediatr. 2014 Jun;164(6):1462-8.e2
pubmed: 24661340
Acta Neurochir Suppl. 2012;113:9-14
pubmed: 22116414
Acta Neurochir (Wien). 1992;119(1-4):12-6
pubmed: 1481738
Acta Neurol Scand. 2008 Sep;118(3):182-8
pubmed: 18513347
AJR Am J Roentgenol. 1986 Aug;147(2):353-6
pubmed: 3524165
AJNR Am J Neuroradiol. 1991 Jan-Feb;12(1):143-7
pubmed: 1903573
BMC Bioinformatics. 2011 Mar 17;12:77
pubmed: 21414208
Eur J Anaesthesiol Suppl. 2008;42:137-41
pubmed: 18289431
Acta Neurochir Suppl. 2008;102:137-40
pubmed: 19388305
Acta Neurochir Suppl. 2016;122:347-51
pubmed: 27165934
Crit Rev Biomed Eng. 2016;44(1-2):91-7
pubmed: 27652453
Neuropsychol Rev. 2016 Dec;26(4):329-339
pubmed: 27815765
J Neurol Neurosurg Psychiatry. 1996 May;60(5):549-58
pubmed: 8778261
Acta Neurochir Suppl. 2002;81:27-30
pubmed: 12168323
Acta Neurol Scand. 2009 Nov;120(5):317-23
pubmed: 19456302