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Updated: Dec 31, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
High-Resolution MRI for Evaluation of Ventriculostomy Tubes: Assessment of Positioning and Proximal Patency
A M Blitz1,2,3, P P Huynh2, L W Bonham2
1From the Department of Radiology (A.M.B.), University Hospitals, Case Western Reserve University ari.blitz@uhhospitals.org.
Background And Purpose:
Imaging evaluation of ventriculostomy tubes, despite the frequency of malfunction, has remained inadequate due to the absence of a systematic way of assessing the catheter itself. In this retrospective review, we assessed the utility of high-resolution 3D MR imaging techniques, including CISS and volumetric interpolated breath-hold examination sequences, in the evaluation of ventriculostomy catheters.
Materials And Methods:
We performed a retrospective review of 23 clinical MR imaging cases of shunted hydrocephalus spanning a 3-year period, all depicting ventriculostomy catheters. The MR imaging examinations included isotropic CISS and volumetric interpolated breath-hold examination sequences performed with and without contrast. These were independently evaluated by 2 neuroradiologists with respect to the catheter course, side hole position, relationship of the side holes to the ventricles, patency, and the presence or absence of intraluminal debris.
Results:
The catheter tip was best seen on isotropic CISS sequences reformatted in an oblique plane, and side holes were visualized as CSF signal defects along the catheter wall in 10/23 (43%) cases. The relationship of the catheter side holes to the ventricles was seen in 47% of cases and was best visualized on the coronal CISS sequences. Catheter patency was confirmed in 12/23 (52%) cases, while the other 48% were notable for T2 hypointense filling defects compatible with luminal obstruction. Enhancement of some of these filling defects on imaging is suggestive of choroid plexus ingrowth rather than debris.
Conclusions:
High-resolution 3D MR imaging using isotropic CISS sequences allows systematic evaluation of catheter positioning, patency, and potential etiologic differentiation of filling defects when shunt dysfunction is suspected.
Insights
High-resolution 3D MR imaging, specifically CISS sequences, offers a systematic method for evaluating ventriculostomy catheters. This technique aids in assessing catheter positioning, patency, and identifying causes of shunt malfunction.
Area of Science:
- Neurosurgery
- Radiology
- Medical Imaging
Background:
- Ventriculostomy catheter malfunction is common.
- Current imaging methods for assessing these catheters are inadequate.
- A systematic approach to evaluating catheter integrity is needed.
Purpose of the Study:
- To assess the utility of high-resolution 3D MR imaging techniques.
- To evaluate the effectiveness of CISS and volumetric interpolated breath-hold examination sequences.
- To systematically assess ventriculostomy catheters for positioning, patency, and debris.
Main Methods:
- Retrospective review of 23 shunted hydrocephalus cases over 3 years.
- Utilized isotropic CISS and volumetric interpolated breath-hold examination MR sequences.
- Two neuroradiologists evaluated catheter course, side hole position, patency, and intraluminal debris.
Main Results:
- Catheter tips best visualized on oblique CISS reformats.
- Side holes seen as CSF signal defects in 43% of cases.
- Catheter patency confirmed in 52%; obstruction noted in 48%.
- Enhancement suggests choroid plexus ingrowth over debris.
Conclusions:
- High-resolution 3D MR imaging with CISS sequences enables systematic evaluation.
- This technique aids in assessing catheter positioning and patency.
- It helps differentiate causes of filling defects in suspected shunt dysfunction.
