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Nuclear Medicine
Central Nervous System
Cerebrospinal Fluid
CSF Shunt Patency
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 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. Schmieder S et al: CSF-oma identification with nuclear medicine shunt-o-gram. Clin Nucl Med. 44(5):399-400, 2019
            2. Bermo MS et al: Two signs indicative of successful access in nuclear medicine cerebrospinal fluid diversionary shunt studies. Pediatr Radiol. 48(8):1130-8, 2018
            3. Kale HA et al: Intracranial perishunt catheter fluid collections with edema, a sign of shunt malfunction: Correlation of CT/MRI and nuclear medicine findings. AJNR Am J Neuroradiol. 38(9):1754-7, 2017
            4. Nigim F et al: Shunting for hydrocephalus: analysis of techniques and failure patterns. J Surg Res. 191(1):140-7, 2014
            5. Sivaganesan A et al: Neuroimaging of ventriculoperitoneal shunt complications in children. Pediatr Radiol. 42(9):1029-46, 2012
            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 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. Schmieder S et al: CSF-oma identification with nuclear medicine shunt-o-gram. Clin Nucl Med. 44(5):399-400, 2019
                      2. Bermo MS et al: Two signs indicative of successful access in nuclear medicine cerebrospinal fluid diversionary shunt studies. Pediatr Radiol. 48(8):1130-8, 2018
                      3. Kale HA et al: Intracranial perishunt catheter fluid collections with edema, a sign of shunt malfunction: Correlation of CT/MRI and nuclear medicine findings. AJNR Am J Neuroradiol. 38(9):1754-7, 2017
                      4. Nigim F et al: Shunting for hydrocephalus: analysis of techniques and failure patterns. J Surg Res. 191(1):140-7, 2014
                      5. Sivaganesan A et al: Neuroimaging of ventriculoperitoneal shunt complications in children. Pediatr Radiol. 42(9):1029-46, 2012