Value of computerized shunt infusion study in assessment of pediatric hydrocephalus shunt function—a two center cross-sectional study

Sandra Fernandes Dias , Afroditi–Despina Lalou , Regine Spang , Karin Haas-Lude , G. Matthew , Helen Fernandez , Marek Czosnyka , MU Schuhmann , Z Czosnyka


Abstract: 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 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 (Rout) and ∆ICP plateau were significantly elevated in obstructed shunts, with cut-off thresholds of 8.07 mmHg min/ml and 11.74 mmHg respectively. Subgroup analysis showed smaller ventricles in 69% of revised cases. 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.

Author Sandra Fernandes Dias - [Universitätsklinikum Tübingen Medizinische Fakultät]
Sandra Fernandes Dias,,
, Afroditi–Despina Lalou - [School of Clinical Medicine ( [University of Cambridge (CAM)]]
Afroditi–Despina Lalou,,
- School of Clinical Medicine
, Regine Spang - [Universitätsklinikum Tübingen Medizinische Fakultät]
Regine Spang,,
, Karin Haas-Lude - [Universitätsklinikum Tübingen Medizinische Fakultät]
Karin Haas-Lude,,
, G. Matthew
G. Matthew,,
, Helen Fernandez - [School of Clinical Medicine ( [University of Cambridge (CAM)]]
Helen Fernandez,,
- School of Clinical Medicine
, Marek Czosnyka (FEIT / PE)
Marek Czosnyka,,
- The Institute of Electronic Systems
, MU Schuhmann
MU Schuhmann,,
, Z Czosnyka
Z Czosnyka,,
Journal seriesChilds Nervous System, [Child's Nervous System], ISSN 0256-7040, e-ISSN 1433-0350
Issue year2020
ASJC Classification2700 General Medicine; 2728 Clinical Neurology; 2735 Pediatrics, Perinatology, and Child Health
Languageen angielski
M.Czosnyka_Value of computerized shunt infusion study in assessmentof pediatric hydrocephalus shunt function—atwocentercross-sectional study.pdf 6.15 MB
Score (nominal)70
Score sourcejournalList
ScoreMinisterial score = 70.0, 20-07-2020, ArticleFromJournal
Publication indicators Scopus Citations = 1; Scopus SNIP (Source Normalised Impact per Paper): 2018 = 0.804; WoS Impact Factor: 2018 = 1.327 (2) - 2018=1.347 (5)
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