Arthur E Marlin1, Sarah J Gaskill. 1. Department of Neurosurgery and Brain Repair, Division of Pediatric Neurosurgery, University of South Florida, Tampa, Florida 33606, USA.
Abstract
BACKGROUND: The diagnosis of shunt malfunction is largely made by subjective clinical history and assessment in association with neurodiagnostic imaging. OBJECTIVE: : To evaluate the use of a transcutaneous thermal convection device for the diagnosis of shunt malfunction. METHODS: We present the results of a trial of a commercially available device under an Institutional Review Board-approved protocol. All patients had neurodiagnostic studies that defined their shunt function at the time of transcutaneous thermal convection measurement. Thirty-seven shunts were studied in 35 patients. To be included, patients had to be between 0 to 18 years of age, had to be due within a 3-month period for routine follow-up evaluations, and had to have neurodiagnostic imaging (computed tomography or magnetic resonance imaging) as part of this visit and a shunt series. All patients were seen in routine follow-up, and none had clinical symptoms of shunt malfunction. RESULTS: Three patients had fractured shunts. The remaining 32 patients had functioning shunts as determined by clinical criteria, computed tomography or magnetic resonance imaging scans, and, when appropriate, a shunt series. In these remaining patients, flow was initially confirmed in only 40%. After some filtering of the data, this was increased to 51%. Although these results are disappointing, they outline the current issues with the technique and the state of its utility and point to the need for further refinement. CONCLUSION: Our current research suggests that cerebrospinal fluid flow as detected by thermoconvection analysis is not a reliable indicator of shunt function in the pediatric population.
BACKGROUND: The diagnosis of shunt malfunction is largely made by subjective clinical history and assessment in association with neurodiagnostic imaging. OBJECTIVE: : To evaluate the use of a transcutaneous thermal convection device for the diagnosis of shunt malfunction. METHODS: We present the results of a trial of a commercially available device under an Institutional Review Board-approved protocol. All patients had neurodiagnostic studies that defined their shunt function at the time of transcutaneous thermal convection measurement. Thirty-seven shunts were studied in 35 patients. To be included, patients had to be between 0 to 18 years of age, had to be due within a 3-month period for routine follow-up evaluations, and had to have neurodiagnostic imaging (computed tomography or magnetic resonance imaging) as part of this visit and a shunt series. All patients were seen in routine follow-up, and none had clinical symptoms of shunt malfunction. RESULTS: Three patients had fractured shunts. The remaining 32 patients had functioning shunts as determined by clinical criteria, computed tomography or magnetic resonance imaging scans, and, when appropriate, a shunt series. In these remaining patients, flow was initially confirmed in only 40%. After some filtering of the data, this was increased to 51%. Although these results are disappointing, they outline the current issues with the technique and the state of its utility and point to the need for further refinement. CONCLUSION: Our current research suggests that cerebrospinal fluid flow as detected by thermoconvection analysis is not a reliable indicator of shunt function in the pediatric population.
Authors: Joseph R Madsen; Tehnaz P Boyle; Mark I Neuman; Eun-Hyoung Park; Mandeep S Tamber; Robert W Hickey; Gregory G Heuer; Joseph J Zorc; Jeffrey R Leonard; Julie C Leonard; Robert Keating; James M Chamberlain; David M Frim; Paula Zakrzewski; Petra Klinge; Lisa H Merck; Joseph Piatt; Jonathan E Bennett; David I Sandberg; Frederick A Boop; Mustafa Q Hameed Journal: Neurosurgery Date: 2020-10-15 Impact factor: 4.654