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Screening for ventricular shunt function in children with hydrocephalus secondary to meningomyelocele
G S Liptak1, H M Bolander, K Langworthy
1Children's Hospital at Strong, University of Rochester Medical Center, Rochester, N.Y. 14642, USA. Gregory_Liptak@urmc.rochester.edu
Insights
Routine computerized tomographic (CT) scans are not cost-effective for screening ventricular shunt failure in children with hydrocephalus. Symptom-based diagnosis is as effective as routine CT scans for managing shunt failure outcomes.
Area of Science:
- Pediatric Neurosurgery
- Medical Imaging
- Hydrocephalus Management
Background:
- Hydrocephalus is a common condition in children, often requiring ventricular shunt placement.
- Ventricular shunt failure is a significant complication that necessitates timely diagnosis and intervention.
- Computerized tomographic (CT) scans are frequently used to monitor shunt function in pediatric patients.
Purpose of the Study:
- To evaluate the efficacy and cost-effectiveness of routine computerized tomographic (CT) scans in screening for ventricular shunt failure in children with hydrocephalus.
- To compare the diagnostic yield of routine CT scans versus symptom-based diagnosis for shunt failure.
Main Methods:
- Retrospective review of 112 pediatric patient charts diagnosed with infantile hydrocephalus secondary to meningomyelocele.
- Analysis of shunt failure diagnosis methods, including symptoms, physical findings, and routine CT scans.
- Assessment of complications, length of stay, and outcomes related to the method of diagnosis.
Main Results:
- Over 2,800 CT scans were performed on 112 patients over an average of 12.2 years.
- Shunt failure was predominantly diagnosed by symptoms (76%), with routine CT scans identifying only 8%.
- No statistically significant difference in complications or length of stay was found between symptomatic and routine CT-diagnosed shunt failures.
Conclusions:
- Routine CT scans for asymptomatic shunt failure in pediatric hydrocephalus patients are not demonstrably superior in improving medical outcomes.
- Current screening methods suggest that symptom-based diagnosis is more prevalent and equally effective in managing shunt failure.
- Further prospective studies are recommended to evaluate the impact of routine CT scans on cognitive and psychological functioning before their elimination.
Objective:
To evaluate the current method of using computerized tomographic (CT) scans to screen for ventricular shunt failure in children who have hydrocephalus.
Design:
Retrospective review of 112 randomly selected charts.
Patients:
Children diagnosed with infantile hydrocephalus secondary to meningomyelocele, who were treated at the Andrew J. Kirch Developmental Services Center since 1978.
Results:
One hundred and twelve patients were monitored with CT scans for an average of 12.2 years. There was a total of 2,869 CT scans and an average of 2.1 CT scans per year. Shunt failure was diagnosed 76% of the time by symptoms, 15% by physical findings and 8% by routine CT scans. Sixteen patients had no shunt failure, whereas the remaining 96 had 255 shunt failures. Complications occurred during 30 of the 255 admissions. One child died due to complications directly related to shunt failure. No statistically significant correlations were found between the length of stay or complications and method of diagnosis.
Conclusions:
Although children in this study received frequent CT scans, 76% of the episodes of shunt failure were diagnosed because of symptoms. Children admitted to the hospital with symptomatic shunt failure did not have more complications or a longer stay than those diagnosed by routine CT scan. This study suggests that the use of routine CT scans to diagnose shunt failure while patients are asymptomatic does not lead to significantly better medical outcomes and is not cost-effective. However, before routine CT scans are eliminated, a prospective study needs to be conducted that examines outcomes such as cognitive and psychological functioning.
