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CSF Shunt Patency
Akiva Mintz, MD, PhD, MHA, CFA; Tejaswini Vasamsetty, MD
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      TERMINOLOGY

      • Definitions

        • Cerebrospinal fluid (CSF) shunt: Surgically inserted drain that routes excess CSF in ventricles to a site where it is absorbed or collected
          • Proximal catheter is positioned in ventricular system
          • Reservoir with valve is located underneath scalp
          • Distal catheter ends in draining space
            • Ventriculoperitoneal (VP) shunt
              • Peritoneal cavity preferred since distal site has considerably better absorptive capacity and accessibility
            • Ventriculopleural (VPL) shunt
            • Ventriculoatrial (VA) shunt
        • Endoscopic 3rd ventriculostomy
          • New alternative to shunting
          • Small opening in floor of 3rd ventricle allows free flow of intraventricular CSF into subarachnoid space
          • Used in patients with uncomplicated noncommunicating hydrocephalus caused by aqueductal stenosis or space-occupying lesions
          • Low infection risk
          • Symptoms gradually resolve (weeks to months)

      IMAGING

      • Imaging Recommendations

        DIFFERENTIAL DIAGNOSIS

          CLINICAL ISSUES

          • Presentation

            Selected References

            1. Nigim F et al: Shunting for hydrocephalus: analysis of techniques and failure patterns. J Surg Res. 191(1):140-7, 2014
            2. Stone JJ et al: Revision rate of pediatric ventriculoperitoneal shunts after 15 years. J Neurosurg Pediatr. 11(1):15-9, 2013
            3. Gonda DD et al: Ventriculoperitoneal shunting versus endoscopic third ventriculostomy in the treatment of patients with hydrocephalus related to metastasis. Surg Neurol Int. 3:97, 2012
            4. Sivaganesan A et al: Neuroimaging of ventriculoperitoneal shunt complications in children. Pediatr Radiol. 42(9):1029-46, 2012
            5. Kharkar S et al: Radionuclide shunt patency study for evaluation of suspected ventriculoperitoneal shunt malfunction in adults with normal pressure hydrocephalus. Neurosurgery. 64(5):909-16; discussion 916-8, 2009
            6. Ouellette D et al: Additive value of nuclear medicine shuntograms to computed tomography for suspected cerebrospinal fluid shunt obstruction in the pediatric emergency department. Pediatr Emerg Care. 25(12):827-30, 2009
            7. Vernet O et al: Radionuclide shuntogram: adjunct to manage hydrocephalic patients. J Nucl Med. 37(3):406-10, 1996
            8. Estrada K: Notes on Nuclear Medicine Imaging (2008)
            Related Anatomy
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            Related Differential Diagnoses
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            References
            Tables

            Tables

            KEY FACTS

            • Imaging

              • Top Differential Diagnoses

                TERMINOLOGY

                • Definitions

                  • Cerebrospinal fluid (CSF) shunt: Surgically inserted drain that routes excess CSF in ventricles to a site where it is absorbed or collected
                    • Proximal catheter is positioned in ventricular system
                    • Reservoir with valve is located underneath scalp
                    • Distal catheter ends in draining space
                      • Ventriculoperitoneal (VP) shunt
                        • Peritoneal cavity preferred since distal site has considerably better absorptive capacity and accessibility
                      • Ventriculopleural (VPL) shunt
                      • Ventriculoatrial (VA) shunt
                  • Endoscopic 3rd ventriculostomy
                    • New alternative to shunting
                    • Small opening in floor of 3rd ventricle allows free flow of intraventricular CSF into subarachnoid space
                    • Used in patients with uncomplicated noncommunicating hydrocephalus caused by aqueductal stenosis or space-occupying lesions
                    • Low infection risk
                    • Symptoms gradually resolve (weeks to months)

                IMAGING

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    CLINICAL ISSUES

                    • Presentation

                      Selected References

                      1. Nigim F et al: Shunting for hydrocephalus: analysis of techniques and failure patterns. J Surg Res. 191(1):140-7, 2014
                      2. Stone JJ et al: Revision rate of pediatric ventriculoperitoneal shunts after 15 years. J Neurosurg Pediatr. 11(1):15-9, 2013
                      3. Gonda DD et al: Ventriculoperitoneal shunting versus endoscopic third ventriculostomy in the treatment of patients with hydrocephalus related to metastasis. Surg Neurol Int. 3:97, 2012
                      4. Sivaganesan A et al: Neuroimaging of ventriculoperitoneal shunt complications in children. Pediatr Radiol. 42(9):1029-46, 2012
                      5. Kharkar S et al: Radionuclide shunt patency study for evaluation of suspected ventriculoperitoneal shunt malfunction in adults with normal pressure hydrocephalus. Neurosurgery. 64(5):909-16; discussion 916-8, 2009
                      6. Ouellette D et al: Additive value of nuclear medicine shuntograms to computed tomography for suspected cerebrospinal fluid shunt obstruction in the pediatric emergency department. Pediatr Emerg Care. 25(12):827-30, 2009
                      7. Vernet O et al: Radionuclide shuntogram: adjunct to manage hydrocephalic patients. J Nucl Med. 37(3):406-10, 1996
                      8. Estrada K: Notes on Nuclear Medicine Imaging (2008)