Hydrocephalus Resource Library: Shunt Taps for Shunt Malfunction in Hydrocephalus

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hydrocephalus resource library logoEach week we will feature an article from our Hydrocephalus Resource Library. Since shunts are the mainstay treatment for hydrocephalus, we will begin with an interesting paper regarding malfunction and taps. Shunt malfunction can often be difficult to diagnose. MRI and CT scans are commonly used, but ventricle size does not always change in people with malfunctioning shunts. It is critical that further shunt studies be performed to assess shunt function.

We thank Drs. Rocque, Lapsiwala and Iskandar from the University of Wisconsin, Madison, dept. of Neurosurgery for this excellent paper.

Ventricular shunt tap as a predictor of proximal shunt malfunction in children: a prospective study

6 Comments for : Hydrocephalus Resource Library: Shunt Taps for Shunt Malfunction in Hydrocephalus
  1. Reply

    I want to write a follow-up note to my earlier comment, and to the use of “shunt taps” as a diagnostic tool in shunt malfunctions. After living with hydrocephalus now for almost 19 years, 8 revisions, and undertaking extensive efforts to advance the care and treatment of hydrocephalus, I think I can now speak confidently that CT and MRI scans are widely misunderstood and misreported. I mean, there is a lot more information that can be gleaned from appropriate chronological analysis of a CT or MRI exam. I am also finding that radiologist often misunderstand the role of the CT or MRI, and what is meant by “baseline ventricular size, and an increase or decrease from this baseline.

    First, I like to list a link to a comment I left this evening on the HA blog regarding personal records. In that post, I talk about the importance of creating a collage of comparible transaxial slices of the lateral ventricles. Here’s the link:


    The “baseline” which I refer to above is the patient’s ventricular size when he/she is the least symptomatic. In other words, what did your CT or MRI look like when you really felt well! From then on, every scan should be compared to that “baseline.” It is best if you can identify a single transaxial slice of the ventricles for easy and like slice comparison. Then, you can analyze the subtle changes in ventricular size from scan to scan. Without this, the nsg or radiologist must look through hundreds of images, and I think this lends itself to a less scientific evaluation method.

    When evaluated as a collage of the same slice as I describe above, it takes the guesswork out of CT and MRI review and you can then see the subtle changes from baseline, which would be indicative of overdrainage and/or slit ventricles, or shunt obstruction or too high of shunt setting.

    The next diagostic tool for hydrocephalus I believe is assigning outcomes and scoring to “markers” that define the hydrocephalus patient’s complaints, then collecting serial data on this via a mobile phone app. Then, you compare the serial data to the patient’s CT and MRI scans and shunt taps. The data, because it is collected in real time in the everyday life of the patient, can alert the patient and nsg to a potential problem that a shunt tap or CT can then better define. I earlier designed the DiaCeph Test for this type of assessment. It could be made to run as a mobile phone app.

    I will undergo my 9th revision in the coming weeks, and I can speak confidently that my diagostic methods have proven to be invaluable over these last 10 years.

    Stephen Dolle

    • Jacqueline
    • May 9, 2011

    My 9 yr old daughter had surgery 3/11/11 for a clogged catheter. Initially she seemed to be doing a little better. The “fuzzballs” and “lightning bolt headaches” had subsided. But something still seemed a little off but I couldn’t put my finger on it. April 18th she awoke with a headache. Knowing that she can have “normal” headaches I gave her some motrine and let her rest a little longer before taking her to school. I was not at work an hour before I got the call from the school nurse that she was vomitting uncontrollablly. I took off without finding my boss, I knew we were in trouble. On the way to the school I contacted her surgeon and was directed to go straight to the ER. They gave her something for the vomitting and IV fluids to rehydrate her. Then off for the X-rays and CTs as had become the norm. They showed no problems. We were sent home to monitor her at home. The following Monday she was admitted to the hospital for additional IV fluid and this time a shunt tap. The tap only produced 2 “wet bubbles”. The shunt was dead. She was scheduled for surgery the next morning but was bumped due to an emergency case that came in. The next morning when she was due to go to surgery she was bumped again for trama for the victims from the early morning tornados. I was trying to be understanding and of course life or death cases should take priority but I was starting to get frustrated sitting in the hospital watching my daughter suffer. The next morning we were scheduled for surgery but I knew for sure that we would be bumped after the devastating night of tornados that ripped across our state and city. It was late in the day but she was taken to surgery as her surgeon said he did not want her to be bumped another day. The surgery was such a success that after having surgery on Thursday she returned to school the following Monday for 1/2 days. If the shunt had been tapped after the first surgery I wonder if she would have left the hospital with a dead shunt or if it died afterwards. As tramatic as a tapping of the shunt is for my daughter multiple surgeries are worse. Because her shunt had to be moved this last time a complete shave of her head was necessary. You have never seen a more beautiful 9 yr old girl hold her head high and return to her class entering saying “Hi everybody!” I have never been so proud or inspired in my life. She has more inner strength than me.

    • tonya g
    • April 28, 2011

    I am 35 years old and have been shunted since I was 6 months old. I, personally, prefer the shunt tap over the CT, because the CT is a waste of my money & time. I would rather the doctor go ahead and tap the shunt to check the pressure and repair the problem as opposed to me throwing my guts up on the CT table. I don’t mean to sound so disgusted but I have been through this so many times, as I’m sure everyone else has, and I feel that if the patient has had a shunt since birth that he/ she should know what they are talking about. Therefore, I feel that the doctor should listen more to the patient… Nobody wants to get a needle stuck in their head because it feels good, but if it helps you to get back to normal quicker, then why not?

    • Hilary
    • April 23, 2011

    My neurosurgeon pumped my reservoir as a diagnostic when I was having symptoms of shunt malfunction. If it provides him with good information, I preferred this noninvasive technique to a shunt tap. I also think the pumping might have cleared a partial clog.

    diagnosed with NPH 2008, shunted 2009

  2. Reply

    The results reported by Dr. Rocque and their group in this study are similar to what I found in my “percutaneous shunt reservoir” evaluations with my DiaCeph Test. Though percutaneous assessment is crude in comparison, I found it surprisingly sensitive to priximal obstruction and to determining how much/when the shunt valve (distal to it) is closed. The latter helped me in my evaluations of overfunction of SCD mechanisms within my Delta shunt, and determining when the valve was open/closed in my Hakim and current OSVII valves. I do not advocate routine pumping of the shunt reservoir, but to the skilled clinician who has worked with this method, I believe it is an invaluable part of the clnical workup for shunt malfunction.

    Another non-invasive method I think worth persuing in the clinical setting is the use of an “applied kinesiology” technique in the evaluation of shunt malfunction, for determining if any portions of a shunt system are causing meridian energy deficits in the hydrocephalus patient’s body. The methods and reliability of applied kinesilogy are well known particularly in Eastern Medicine, but controversial in Western Medicine. However, as part of an in-office evaluation I think such an assessment is worth the couple minutes of time as it CAN help steer subsequent diagnostic testing to the source of a malfunction. A good part of medicine, particularly in hydrocephalus care, remains a “fishing expedition” still today. In these regards, one needs to also embrace the available tools.

    Stephen Dolle
    Hydrocephalus Dx 1992

    • Glen Carney
    • April 18, 2011

    This article is wonderful, I am 35 yrs old and have had a total of 90 surgeries, I have congenital Hydrocephalus and had 48 vp shunt revisions and the rest LP revisions along with a chari I malformation later in life. So I can certain understand how doctors have a difficult time understanding the ventricle size not showing enlargment during malfunction. I am a true believer in the parents know best and as an adult, the individual knows best. To sum it all up I am very blessed with 2 healthy boys a beautiful wife and I function well enough to have worked as a Correction Officer in CT for 13 years. So to all parents with children suffering with hydrocephalus remember you know what your child needs more than any doctor. Glen Carney CT

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