Shuntogram utility in predicting future shunt failures

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  • 1 Department of Neurosurgery, Albany Medical Center, Albany, New York
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OBJECTIVE

Shunt failure remains a challenging diagnosis for neurosurgeons, particularly when patient symptoms suggest shunt malfunction but radiographic evidence is lacking. In such situations, shuntograms are sometimes employed to guide medical decision-making. In this study, the authors aimed to investigate the utility of shuntograms in aiding patient management, particularly in terms of a negative result.

METHODS

This retrospective single-institution series comprises patients who underwent a shuntogram procedure to evaluate shunt patency over a roughly 6-year period. The medical records of patients were reviewed to determine the findings of the shuntogram procedure, the type of obstruction, and whether a subsequent operation for a shunt revision took place either within 30 days or up to 1 year after the procedure. Statistical analysis was completed by calculating the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of the shuntogram as compared with the revision surgery.

RESULTS

Of the 98 patients who underwent a shuntogram, 95 patients were included in the statistical analysis. A ventriculoperitoneal shunt was assessed in 81% of patients (77/95). The PPV of the procedure was 100%. The NPV for predicting a subsequent shunt revision within 30 days was 68.3% (false-negative rate of 31.7%) or within 365 days was 61.2% (false-negative rate of 38.8%). The sensitivity and specificity of the shuntogram were 55.8% and 100% within 30 days and 51.9% and 100% within 365 days, respectively. The most common intervention at the time of surgery following a negative shuntogram was a valve replacement in 38.5% of patients (10/26).

CONCLUSIONS

With an NPV of 68.3% for predicting revision within 30 days in our series of 95 patients, shuntograms remained a useful tool in the clinical decision-making process when evaluating potential shunt failure.

ABBREVIATIONS

NPV = negative predictive value; PPV = positive predictive value.

Illustration from Seaman et al. (pp 260–267). Copyright Jane Whitney. Published with permission.

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Contributor Notes

Correspondence Michael W. O’Brien: Albany Medical Center, Albany, NY. obrienm3@amc.edu.

INCLUDE WHEN CITING Published online June 25, 2021; DOI: 10.3171/2021.2.PEDS2161.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Fishman MA. Hydrocephalus. In: Eliasson SG, Prensky AL, Hardin WB, eds. Neurological Pathophysiology. Oxford; 1978.

  • 2

    Carey CM, Tullous MW, Walker ML. Hydrocephalus: etiology, pathologic effects, diagnosis, and natural history. In: Cheek WR, ed. Pediatric Neurosurgery. 3rd ed. WB Saunders Co; 1994.

    • Search Google Scholar
    • Export Citation
  • 3

    Pujari S, Kharkar S, Metellus P, et al. Normal pressure hydrocephalus: long-term outcome after shunt surgery. J Neurol Neurosurg Psychiatry. 2008;79(11):12821286.

    • Search Google Scholar
    • Export Citation
  • 4

    Raftopoulos C, Massager N, Balériaux D, et al. Prospective analysis by computed tomography and long-term outcome of 23 adult patients with chronic idiopathic hydrocephalus. Neurosurgery. 1996;38(1):5159.

    • Search Google Scholar
    • Export Citation
  • 5

    Vassilyadi M, Tataryn ZL, Matzinger MA, et al. Radioisotope shuntograms at the Children’s Hospital of Eastern Ontario. Childs Nerv Syst. 2006;22(1):4349.

    • Search Google Scholar
    • Export Citation
  • 6

    O’Brien DF, Taylor M, Park TS, Ojemann JG. A critical analysis of ‘normal’ radionucleotide shuntograms in patients subsequently requiring surgery. Childs Nerv Syst. 2003;19(5-6):337341.

    • Search Google Scholar
    • Export Citation
  • 7

    May CH, Aurisch R, Kornrumpf D, Vogel S. Evaluation of shunt function in hydrocephalic patients with the radionuclide 99mTc-pertechnetate. Childs Nerv Syst. 1999;15(5):239245.

    • Search Google Scholar
    • Export Citation
  • 8

    Thompson EM, Wagner K, Kronfeld K, Selden NR. Using a 2-variable method in radionuclide shuntography to predict shunt patency. J Neurosurg. 2014;121(6):15041507.

    • Search Google Scholar
    • Export Citation

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