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Updated: Jun 28, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
The Utilization of Computed Tomography in the Pediatric Emergency Department for Patients With Ventriculoperitoneal
Hamoud Alqarni1, Raiyan Almaini2, Aiydh Alharbi3
1Pediatrics, King Abdulaziz Medical City, Riyadh, SAU.
Insights
Children with ventriculoperitoneal (VP) shunts undergo frequent computed tomography (CT) scans, leading to significant radiation exposure and increased cancer risk. Rationalizing CT use in pediatric emergency care is crucial, as many scans show unremarkable findings.
Area of Science:
- Pediatric Radiology
- Neurosurgery
- Radiation Oncology
Background:
- Ventriculoperitoneal (VP) shunts are common in children, often requiring frequent computed tomography (CT) scans for malfunction evaluation.
- High radiation doses from CT scans in pediatric patients raise concerns about long-term cancer risks.
Purpose of the Study:
- To quantify the utilization of CT scans in pediatric emergency departments for suspected VP shunt malfunction.
- To assess the diagnostic yield of CT scans in this patient population.
Main Methods:
- Retrospective chart review of pediatric patients with suspected VP shunt malfunction.
- Data collected from King Abdullah Specialist Children Hospital, Riyadh, Saudi Arabia, between 2018-2019.
- Analysis included patient demographics, CT findings, and neurosurgical interventions.
Main Results:
- 119 children were included; 46.8% had congenital hydrocephalus.
- Median of seven CT scans per patient; 55.6% had abnormal findings.
- Factors associated with abnormal CT (female gender, younger age, cerebral cyst) were not significant in multivariate analysis. Neurosurgical intervention was linked to altered activity, weakness, and mental status.
Conclusions:
- Pediatric patients with VP shunts face substantial radiation exposure from recurrent CT scans, increasing cancer risk.
- CT imaging is valuable but often yields unremarkable findings in this cohort.
- Tailored guidelines are needed to optimize CT utilization and minimize unnecessary radiation exposure.
Abstract:
Introduction Despite all the advantages of computed tomography (CT) scanning, there is a significant concern due to the rising use of CT scans in children with ventriculoperitoneal (VP) shunts. High doses of radiation are absorbed by patients, raising their chance of acquiring cancer. Evaluating a potential VP shunt malfunction is a frequent encounter in the pediatric emergency room, often necessitating the utilization of a CT scan. This study aims to recognize and quantify the utilization of CT scans in an emergency setting for pediatric patients with a clinical suspicion of VP shunt malfunction. Methods This retrospective chart review was conducted on patients who visited the emergency department with suspected VP shunt malfunction in a pediatric tertiary care hospital (King Abdullah Specialist Children Hospital), Riyadh, Saudi Arabia. The study included the files of children between the years 2018 and 2019. Results A total of 119 children were included; the main indication for VP shunt insertion was congenital hydrocephalus at 46.8% (n=52). The median number of CT scans done per patient was seven (IQR=3-9). CT findings were abnormal among 55.6% (n=60). The univariate analysis examining the impact of different factors on CT findings showed an association between an abnormal CT finding and female gender (P=0.017), younger age (P=0.03), and the presence of a cerebral cyst (P=0.001); however, subsequent multivariate analysis was not significant for any of these factors. Twenty-two point three percent (n=25) of the patients required neurosurgical intervention, and the associated factors with neurosurgical intervention included changes in activity level (P=0.04), weakness (P=0.004), and altered mental status (P=0.001). Conclusion Children with VP shunts are susceptible to significant radiation exposure through the utilization of CT scans whenever they present to the ER with suspected shunt malfunction during their lifespan, which puts them at risk of radiation-related complications, such as cancers. CT imaging remains a helpful tool aiding physicians in making accurate decisions. However, in this study, almost half of the children had unremarkable CT findings. Thus, it is imperative to rationalize its use by establishing tailored guidelines that delineate the appropriate circumstances warranting its application.
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