RESEARCH ARTICLE


The Neuroimaging Studies in Children with Ventriculoperitoneal Shunt Complications: A 10 Years Descriptive Study in Tehran



Mohammad Vafaee Shahi1, Samileh Noorbakhsh2, *, Vida Zarrabi3, Banafsheh Nourozi4, Leila Tahernia2
1 Pediatric Department, Pediatric growth and development research center, Institute of Endocrinology and Metabolism, University of Medical Sciences, Tehran, Iran
2 Department of pediatric infectious diseases , University of Medical Sciences. Tehran, Iran
3 Department of Radiology University of Medical Sciences, Tehran, Iran
4 Department of Pediatric, University of Medical Sciences, Tehran, Iran
5 Department of Pediatric, Tehran University of Medical Sciences, Tehran, Iran


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© 2018 Shahi et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this authors at the Pediatric Infectious Disease, pediatric infectious diseases Department, Iran University of Medical Sciences, Tehran, Iran, Tel: 098-21-66525328; E-mail: samileh_noorbakhsh@yahoo.com


Abstract

Background:

Any mismatch between the production and absorption of CSF results in hydrocephalus. In most cases, the selected choice of treatment is the ventriculoperitoneal shunt insertion. Although, the surgery could have complications such as infection, shunt malfunction, subdural hematoma, seizure and Shunt immigration; so, the early and proper detection of these complications could result in better prognosis. The aim of this study was to evaluate and compare the efficacy of CT scan, CSF analysis and X-ray radiography in detection of shunt complications and problems in shunt placement and further follow-up in hospitalized children.

Methods:

The medical records of children in Rasul Akram hospital in Tehran were reviewed retrospectively in the last 10 years, from 2006 to 2016. All data were recorded in the prepared form including the age, sex, shunt complication, CT scan and CSF characteristics.

Results:

The total number of 95 patients were interfered in this study including 56 males (58.9%) and 39 females (41.1%). The mean age at the onset of complications were 2.8±2.2 years-old. The shunt obstruction (60%) and infection (25.3%) were the most common complications. The CT scan was able to detect 36.5% of shunt complications. The CT scan had the sensitivity and specificity of 50 and 87%, respectively in detection of shunt obstruction. The all cases of brain hematoma and hemorrhage were revealed by CT scan. On the other hand, the CT scan had 20% of sensitivity and 60% of specificity in the detection of shunt infection. The CSF evaluation in shunt infection revealed 92% hypoglycemia, 87.5% pleocytosis, and 62.5% positive CSF culture. CSF had the sensitivity, specificity, positive predictive value and negative predictive value of 92, 82, 63 and 97%, respectively. The patient's symptoms and signs were helpful in obtaining higher test accuracy.

Conclusion:

The CT scan was not a good sensitive and specific study in the detection of shunt obstruction and infection, but it was very accurate in detection of hemorrhage and hematoma. On the other hand, CSF evaluation was a reliable test in shunt infection disclosure.

Keywords: Brain CT scan, Cerebrospinal fluid, Children, Ventriculo peritoneal shunt, Neuroimaging, hydrocephalus.