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evaluation_of_the_patient_with_a_shunt [2021/04/10 11:51]
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-====== Evaluation of the patient with a shunt ====== 
-Radiographic evaluation 
-1. “shunt series” (plain X-rays to visualize entire shunt) 
-a) purpose:R/Odisconnection/breakageormigrationoftip(NB:adisconnectedshuntmaycon- 
-tinue to function by CSF flow through a subcutaneous fibrous tract) 
-b) foraVPshunt:AP&lateralskull,CXRandabdominalX-ray 
-c) the following hardware may be radiolucent and can mimic disconnection: 
-● the central silastic part of older Holter style valves 
-● connectors (“Y” & “T” as well as straight) 
-● antisiphon devices 
-● tumor filters 
-d) obtainmostrecentX-raysavailabletocompareforbreaks(essentialfor“complicated”shunts involving multiple ventricular or cyst ends or accessory hardware) 
-2. in infants with open fontanelles, ultrasound is optimal method of evaluation (especially if pre- vious U/S available) 
-3. brain CT required if fontanelles closed, may be desirable in complicated shunt systems (e.g. cyst shunts). Minimize the number of CTs in pediatric patients 
-4. brain MRI: best for assessing specific issues related to hydrocephalus (aqueductal stenosis, trans- ependymal absorption of CSF, loculations... Shunt hardware is difficult to see on MRI. Programmable valves must be evaluated and reprogrammed after an MRI 
-5. “shunt-o-gram” if it is still unclear if shunt is functioning a) radionuclide:seebelow 
-b) X-ray:usingiodinatedcontrast:seebelow 
-6. abdominal CT or abdominal ultrasound: when undershunting is unexplained or if there is an index of suspicion of abdominal obstruction (e.g. abdominal symptoms such as pain or bloating)