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Updated: May 5, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
MR CSF Flow Examination as a Non-Invasive Method of Determining Shunt-Independent Hydrocephalus in Children with
M Szafirska1, A Urbanik, I Herman-Sucharska
1Radiology Department, Jagiellonian University, Collegium Medicum First; Krakow, Poland - mszafir@poczta.onet.pl.
Insights
Magnetic Resonance (MR) imaging assesses cerebrospinal fluid (CSF) flow in ventriculoperitoneal shunts. This MR CSF flow examination helps diagnose shunt-dependent hydrocephalus by detecting flow, even without clinical signs of obstruction.
Area of Science:
- Neurology
- Medical Imaging
- Pediatric Neurosurgery
Background:
- Ventriculoperitoneal shunts are crucial for managing hydrocephalus.
- Evaluating shunt function is vital, especially in pediatric patients.
- Clinical signs of shunt obstruction are not always apparent.
Purpose of the Study:
- To evaluate the utility of MR imaging in assessing cerebrospinal fluid (CSF) flow through ventriculoperitoneal shunts.
- To differentiate between shunt-dependent and shunt-independent hydrocephalus.
- To determine the role of MR CSF flow examination in diagnosing shunt impatency.
Main Methods:
- MR examination of CSF flow in the cranial portion of ventriculoperitoneal shunts.
- Study included 16 pediatric patients (8-18 years) with ventriculoperitoneal shunts.
- Utilized a Signa Horizon 1.5T MR unit with 2D CINE/GR/PC sequences for flow analysis.
Main Results:
- MR CSF flow examination successfully detected the presence or absence of CSF flow.
- Eleven patients showed CSF flow (0.1-1.9 ml/min), indicating shunt-dependent hydrocephalus.
- Five patients had no detectable CSF flow, suggesting shunt-independent hydrocephalus.
Conclusions:
- MR CSF flow examination is effective in determining CSF flow direction and velocity.
- Absence of flow on MR may indicate shunt-independent hydrocephalus, even without clinical symptoms.
- Presence of CSF flow on MR confirms shunt-dependent hydrocephalus.
Unlabelled:
The study discusses the value of MR examination of CSF flow through the cranial part of the ventriculoperitoneal shunt in the evaluation of shunt-dependent hydrocephalus. Sixteen patients aged eight to 18 years were examined in the course of many years of treatment using the ventriculoperitoneal shunt. No clinical manifestations of shunt obstruction had been observed in any of the patients prior to MR examination. A Signa Horizon 1.5T (GEMS) unit was used. Axial and sagittal T1- and T2-weighted images were performed to find the ventriculoperitoneal shunt canal. A 2D CINE/GR/PC sequence was performed in the plane perpendicular to the shunt canal. CSF-flow was calculated by the Flow Analysis program. Patients were divided into two groups: 1) no CSF-flow was noted in five children indicating shunt-independent hydrocephalus; 2) CSF-flow was present (average flow volume from 0.1 to 1.9 ml/min) in 11 children, distinguishing the group with shunt-dependent hydrocephalus.
Conclusions:
1) MR CSF flow examination will establish the absence or presence of CSF flow and determine its direction and velocity. 2) With no clinical manifestations of shunt impatency the absence of flow in the shunt canal found in MR CSF flow examination may indicate shunt-independent hydrocephalus. 3) When the CSF flow in the shunt is found in MR shunt-dependent hydrocephalus is diagnosed.
