The low utility of routine cranial imaging after pediatric shunt revision

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  • 1 Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts;
  • | 2 Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;
  • | 3 Department of Neurosurgery, Haaglanden Medical Center, The Hague, Zuid-Holland, The Netherlands;
  • | 4 Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands;
  • | 5 Department of Neurological Surgery, University of Padua, Padua, Italy;
  • | 6 Harvard-MIT Health Sciences and Technology, Harvard Medical School, Massachusetts Institute of Technology, Cambridge, Massachusetts; and
  • | 7 Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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OBJECTIVE

Postoperative routine imaging is common after pediatric ventricular shunt revision, but the benefit of scanning in the absence of symptoms is questionable. In this study, the authors aimed to assess how often routine scanning results in a change in clinical management after shunt revision.

METHODS

The records of a large, tertiary pediatric hospital were retrospectively reviewed for all consecutive cases of pediatric shunt revision between July 2013 and July 2018. Postoperative imaging was classified as routine (i.e., in the absence of symptoms, complications, or other direct indications) or nonroutine. Reinterventions within 30 days were assessed in these groups.

RESULTS

Of 387 included shunt revisions performed in 232 patients, postoperative imaging was performed in 297 (77%), which was routine in 244 (63%) and nonroutine in 53 (14%). Ninety revisions (23%) underwent any shunt-related procedure after postoperative imaging, including shunt reprogramming (n = 35, 9%), shunt tap (n = 10, 3%), and a return to the operating room (OR; n = 58, 15%). Of the 244 cases receiving routine imaging, 241 did not undergo a change in clinical management solely based on routine imaging findings. The remaining 3 cases returned to the OR, accounting for 0.8% (95% CI 0.0%–1.7%) of all cases or 1.2% (95% CI 0.0%–2.6%) of cases that received routine imaging. Furthermore, 27 of 244 patients in this group returned to the OR for other reasons, namely complications (n = 12) or recurrent symptoms (n = 15); all arose after initial routine imaging.

CONCLUSIONS

The authors found a low yield to routine imaging after pediatric shunt revision, with only 0.8% of cases undergoing a change in management based on routine imaging findings without corresponding clinical findings. Moreover, routine imaging without abnormal findings was no guarantee of an uneventful postoperative course. Clinical monitoring can be considered as an alternative in asymptomatic, uncomplicated patients.

ABBREVIATIONS

NNS = number needed to scan; OR = operating room; VP = ventriculoperitoneal.

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  • 1

    Isaacs AM, Riva-Cambrin J, Yavin D, Hockley A, Pringsheim TM, Jette N, et al. Age-specific global epidemiology of hydrocephalus: systematic review, metanalysis and global birth surveillance. PLoS One. 2018;13(10):e0204926.

    • Search Google Scholar
    • Export Citation
  • 2

    Gliemroth J, Käsbeck E, Kehler U. Ventriculocisternostomy versus ventriculoperitoneal shunt in the treatment of hydrocephalus: a retrospective, long-term observational study. Clin Neurol Neurosurg. 2014;122:9296.

    • Search Google Scholar
    • Export Citation
  • 3

    Reddy GK, Bollam P, Caldito G. Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus. World Neurosurg. 2014;81(2):404410.

    • Search Google Scholar
    • Export Citation
  • 4

    Tervonen J, Leinonen V, Jääskeläinen JE, Koponen S, Huttunen TJ. Rate and risk factors for shunt revision in pediatric patients with hydrocephalus—a population-based study. World Neurosurg. 2017;101:615622.

    • Search Google Scholar
    • Export Citation
  • 5

    Notarianni C, Vannemreddy P, Caldito G, Bollam P, Wylen E, Willis B, Nanda A. Congenital hydrocephalus and ventriculoperitoneal shunts: influence of etiology and programmable shunts on revisions. J Neurosurg Pediatr. 2009;4(6):547552.

    • Search Google Scholar
    • Export Citation
  • 6

    Ahmadvand S, Dayyani M, Etemadrezaie H, Ghorbanpour A, Zarei R, Shahriyari A, et al. Rate and risk factors of early ventriculoperitoneal shunt revision: a five-year retrospective analysis of a referral center. World Neurosurg. 2020;134:e505e511.

    • Search Google Scholar
    • Export Citation
  • 7

    Venable GT, Rossi NB, Morgan Jones G, Khan NR, Smalley ZS, Roberts ML, Klimo P Jr. The preventable shunt revision rate: a potential quality metric for pediatric shunt surgery. J Neurosurg Pediatr. 2016;18(1):715.

    • Search Google Scholar
    • Export Citation
  • 8

    Lee RP, Ajmera S, Thomas F, Dave P, Lillard JC, Wallace D, et al. Shunt failure-the first 30 days. Neurosurgery. 2020;87(1):123129.

  • 9

    Anderson IA, Saukila LF, Robins JMW, Akhunbay-Fudge CY, Goodden JR, Tyagi AK, et al. Factors associated with 30-day ventriculoperitoneal shunt failure in pediatric and adult patients. J Neurosurg. 2018;130(1):145153.

    • Search Google Scholar
    • Export Citation
  • 10

    Gonzalez DO, Mahida JB, Asti L, Ambeba EJ, Kenney B, Governale L, et al. Predictors of ventriculoperitoneal shunt failure in children undergoing initial placement or revision. Pediatr Neurosurg. 2017;52(1):612.

    • Search Google Scholar
    • Export Citation
  • 11

    Hulsbergen AFC, Muskens IS, Gormley WB, Broekman MLD. Unnecessary diagnostics in neurosurgery: finding the ethical balance. World Neurosurg. 2019;125:527528.

    • Search Google Scholar
    • Export Citation
  • 12

    Hulsbergen AFC, Yan SC, Stopa BM, DiRisio A, Senders JT, van Essen MJ, et al. International practice variation in postoperative imaging of chronic subdural hematoma patients. J Neurosurg. 2018;131(6):19121919.

    • Search Google Scholar
    • Export Citation
  • 13

    Schucht P, Fischer U, Fung C, Bernasconi C, Fichtner J, Vulcu S, et al. Follow-up computed tomography after evacuation of chronic subdural hematoma. N Engl J Med. 2019;380(12):11861187.

    • Search Google Scholar
    • Export Citation
  • 14

    Geßler F, Dützmann S, Quick J, Tizi K, Voigt MA, Mutlak H, et al. Is postoperative imaging mandatory after meningioma removal?. Results of a prospective study. PLoS One. 2015;10(4):e0124534.

    • Search Google Scholar
    • Export Citation
  • 15

    Benveniste RJ, Ferraro N, Tsimpas A. Yield and utility of routine postoperative imaging after resection of brain metastases. J Neurooncol. 2014;118(2):363367.

    • Search Google Scholar
    • Export Citation
  • 16

    Halevi PD, Udayakumaran S, Ben-Sira L, Constantini S. The value of postoperative MR in tethered cord: a review of 140 cases. Childs Nerv Syst. 2011;27(12):21592162.

    • Search Google Scholar
    • Export Citation
  • 17

    Binning M, Ragel B, Brockmeyer DL, Walker ML, Kestle JR. Evaluation of the necessity of postoperative imaging after craniosynostosis surgery. J Neurosurg. 2007;107(1)(suppl):4345.

    • Search Google Scholar
    • Export Citation
  • 18

    Behmanesh B, Keil F, Dubinski D, Won SY, Quick-Weller J, Seifert V, Gessler F. The value of computed tomography imaging of the head after ventriculoperitoneal shunt surgery in adults. World Neurosurg. 2019;121:e159e164.

    • Search Google Scholar
    • Export Citation
  • 19

    Kamenova M, Rychen J, Guzman R, Mariani L, Soleman J. Yield of early postoperative computed tomography after frontal ventriculoperitoneal shunt placement. PLoS One. 2018;13(6):e0198752.

    • Search Google Scholar
    • Export Citation
  • 20

    Wen L, Badgett R, Cornell J. Number needed to treat: a descriptor for weighing therapeutic options. Am J Health Syst Pharm. 2005;62(19):20312036.

    • Search Google Scholar
    • Export Citation
  • 21

    Stone SS, Warf BC. Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment for infant hydrocephalus: a prospective North American series. J Neurosurg Pediatr. 2014;14(5):439446.

    • Search Google Scholar
    • Export Citation
  • 22

    Zabramski JM, Preul MC, Debbins J, McCusker DJ. 3T magnetic resonance imaging testing of externally programmable shunt valves. Surg Neurol Int. 2012;3:81.

    • Search Google Scholar
    • Export Citation
  • 23

    Antonucci MC, Zuckerbraun NS, Tyler-Kabara EC, Furtado AD, Murphy ME, Marin JR. The burden of ionizing radiation studies in children with ventricular shunts. J Pediatr. 2017;182:210216.e1.

    • Search Google Scholar
    • Export Citation
  • 24

    Pfeifer CM. Rapid-sequence MRI of the brain: a distinct imaging study. AJNR Am J Neuroradiol. 2018;39(8):E93E94.

  • 25

    Pershad J, Taylor A, Hall MK, Klimo P Jr. Imaging strategies for suspected acute cranial shunt failure: a cost-effectiveness analysis. Pediatrics. 2017;140(2):e20164263.

    • Search Google Scholar
    • Export Citation

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