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Updated: Mar 10, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
The Burden of Ionizing Radiation Studies in Children with Ventricular Shunts
Maria C Antonucci1, Noel S Zuckerbraun1, Elizabeth C Tyler-Kabara2
1Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Insights
Patients with ventricular shunts undergo numerous imaging studies, primarily head CT scans, with most not leading to surgery. This highlights a need to reduce radiation exposure and improve shunt malfunction evaluation.
Area of Science:
- Pediatric Neurosurgery
- Medical Imaging
- Radiology
Background:
- Ventriculoperitoneal shunts are common treatments for hydrocephalus.
- Evaluating shunt malfunction often involves multiple imaging studies.
- Radiation exposure from repeated imaging is a concern in pediatric patients.
Purpose of the Study:
- To quantify imaging study utilization in pediatric patients with ventricular shunts.
- To determine the proportion of computed tomography (CT) scans leading to surgical intervention.
- To assess the long-term imaging burden following shunt placement.
Main Methods:
- Retrospective longitudinal cohort analysis of 130 pediatric patients.
- Follow-up period of 10 years post-shunt placement.
- Analysis of head CT scans, shunt series radiographs, skull radiographs, nuclear medicine, and brain MRI studies.
Main Results:
- Patients underwent a median of 8.5 head CT scans over 10 years, with highest frequency in the first year.
- 17% of 1411 head CT scans resulted in surgical intervention within 7 days.
- Ventriculoperitoneal shunts were used in 97% of cases for conditions like congenital hydrocephalus.
Conclusions:
- Pediatric patients with ventricular shunts are exposed to significant radiation from frequent imaging.
- A majority of imaging studies, particularly head CTs, do not result in surgical intervention.
- There is a critical need to optimize shunt malfunction evaluation to minimize radiation exposure.
Objectives:
To quantify the number of shunt-related imaging studies that patients with ventricular shunts undergo and to calculate the proportion of computed tomography (CT) scans associated with a surgical intervention.
Study Design:
Retrospective longitudinal cohort analysis of patients up to age 22 years with a shunt placed January 2002 through December 2003 at a pediatric hospital. Primary outcome was the number of head CT scans, shunt series radiograph, skull radiographs, nuclear medicine, and brain magnetic resonance imaging studies for 10 years following shunt placement. Secondary outcome was surgical interventions performed within 7 days of a head CT. Descriptive statistics were used for analysis.
Results:
Patients (n = 130) followed over 10 years comprised the study cohort. The most common reasons for shunt placement were congenital hydrocephalus (30%), obstructive hydrocephalus (19%), and atraumatic hemorrhage (18%), and 97% of shunts were ventriculoperitoneal. Patients underwent a median of 8.5 head CTs, 3.0 shunt series radiographs, 1.0 skull radiographs, 0 nuclear medicine studies, and 1.0 brain magnetic resonance imaging scans over the 10 years following shunt placement. The frequency of head CT scans was greatest in the first year after shunt placement (median 2.0 CTs). Of 1411 head CTs in the cohort, 237 resulted in surgical intervention within 7 days (17%, 95% CI 15%-19%).
Conclusions:
Children with ventricular shunts have been exposed to large numbers of imaging studies that deliver radiation and most do not result in a surgical procedure. This suggests a need to improve the process of evaluating for ventricular shunt malfunction and minimize radiation exposure.
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