Doppler flow velocities in children with controlled hydrocephalus: reference values for the diagnosis of blocked cerebrospinal fluid shunts
Related Experiment Videos
1Department of Neurosurgery, Frenchay Hospital, Bristol, UK.
Insights
Doppler flow velocities in children’s middle cerebral artery can non-invasively assess cerebrospinal fluid shunt function. A derived age-reference range helps identify shunt malfunction in hydrocephalus patients.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Medical Imaging
Background:
- Cerebrospinal fluid (CSF) shunts are crucial for managing hydrocephalus.
- Assessing shunt function non-invasively is essential for timely intervention.
- Middle cerebral artery (MCA) Doppler flow velocities may indicate shunt status.
Purpose of the Study:
- To establish a normative reference range for MCA Doppler flow velocities in asymptomatic children with shunts.
- To evaluate the utility of these reference ranges in diagnosing shunt malfunction.
Main Methods:
- Transcranial Doppler (TCD) ultrasound was used to measure MCA flow velocities.
- A reference range was established from 248 asymptomatic children with shunts.
- TCD values were analyzed in 20 children with suspected shunt malfunction.
Main Results:
- MCA Doppler velocities demonstrated age-dependent variations.
- Nine out of eleven children requiring shunt revision had abnormal Doppler values outside the reference range.
- Children who improved without surgery had normal Doppler values within the reference range.
Conclusions:
- MCA Doppler flow velocity reference ranges provide a valuable non-invasive tool for assessing shunt function in pediatric hydrocephalus.
- This method can aid in differentiating between shunt malfunction and other causes of symptoms.
- Implementing TCD assessment can improve the management of CSF shunt systems.
Abstract:
Doppler flow velocities in the middle cerebral artery of children with blocked cerebrospinal fluid shunts show changes that can be used as a non-invasive method for assessing shunt function. The velocities also change with age, and the purpose of this study was to define a reference range of values for children with controlled hydrocephalus. Flow velocities were measured in 248 asymptomatic children with shunts and an age-reference range was derived. Twenty children were subsequently admitted with suspected shunt malfunction and 11 of these required a shunt revision. On admission 9 of the 11 children requiring operation had Doppler values outside the reference range, whereas none of the children whose symptoms settled without surgery had abnormal values. The reference range will facilitate the use of transcranial Doppler for the assessment of children with suspected shunt malfunction.