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Updated: May 21, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Neuroimaging of ventriculoperitoneal shunt complications in children
Ahilan Sivaganesan1, Rajesh Krishnamurthy, Deshdeepak Sahni
1Baylor College of Medicine, Houston, TX, USA.
Insights
Ventriculoperitoneal shunts treat hydrocephalus but can malfunction. This study outlines a systematic approach using patient symptoms and CT scans to diagnose shunt failure, improving patient outcomes.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Neurology
Background:
- Ventriculoperitoneal shunts are primary treatments for hydrocephalus.
- Shunt malfunction, due to obstruction, breakage, migration, or infection, is common.
- A systematic diagnostic approach is crucial for effective management.
Purpose of the Study:
- To present an algorithm for evaluating ventriculoperitoneal shunt malfunction.
- To illustrate radiographic findings associated with shunt failure.
- To guide clinicians in diagnosing the etiology of shunt dysfunction.
Main Methods:
- Patient symptom appraisal for acute and chronic malfunction.
- CT scan of the head to assess ventricular size and changes over time.
- Consideration of alternative diagnostic methods when prior imaging is unavailable.
Main Results:
- Acute malfunction presents with symptoms like nausea, vomiting, seizures, and lethargy.
- Chronic malfunction may manifest as neuropsychological changes, developmental delay, and headaches.
- Enlargement of ventricles on CT scans suggests shunt malfunction, while slit ventricle syndrome is also considered.
Conclusions:
- A systematic evaluation integrating clinical presentation and imaging is essential for diagnosing shunt malfunction.
- Understanding radiographic findings aids in identifying the cause of shunt failure.
- Effective diagnosis leads to timely intervention and improved management of hydrocephalus.
Abstract:
The ventriculoperitoneal shunt is the mainstay of treatment for hydrocephalus. Despite its widespread use and safety record, it often malfunctions due to complications such as obstruction, breakage, migration and infection. This necessitates a systematic approach to diagnosing the etiology of shunt failure. Any evaluation should begin with an appraisal of the patient's symptoms. In acute malfunction, nausea, vomiting, irritability, seizures, headache, lethargy, coma and stupor are seen. In chronic malfunction, neuropsychological signs, feeding pattern changes, developmental delay, decline in school performance, headaches and increased head size are often seen. The next step in evaluation is a CT scan of the head to evaluate ventricular size. Prior imaging studies should be obtained for comparison; if the ventricles have enlarged over time, shunt malfunction is likely. If there is no such increase or dilation in the first place, other diagnoses are possible. However, "slit ventricle syndrome" should also be considered. When prior imaging is not available, pumping the reservoir, a radionuclide shuntogram, a shunt tap or even surgical exploration are options. The goals of this paper are to provide an algorithm for evaluating shunt malfunction and to illustrate the radiographic findings associated with shunt failure.
