The use of quick-brain magnetic resonance imaging in the evaluation of shunt-treated hydrocephalus

Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin 53792, USA.
Journal of Neurosurgery (Impact Factor: 3.74). 12/2004; 101(2 Suppl):147-51. DOI: 10.3171/ped.2004.101.2.0147
Source: PubMed


Children with shunt-treated hydrocephalus are exposed to serious amounts of radiation when undergoing computerized tomography (CT) scanning. The authors report their clinical experience with single-shot fast-spin echo (SSFSE) (quick-brain) magnetic resonance (MR) imaging as the modality of choice for the workup and follow up of patients in whom a shunt has been placed to treat hydrocephalus.
A retrospective chart review was performed to obtain data on all cases in which a quick-brain MR image was acquired for either symptomatic workup or asymptomatic follow-up examination of shunt-treated hydrocephalus. Data regarding demographics, origin of hydrocephalus, MR imaging indications and findings, use of sedation, imaging-related complications, use of adjunctive CT scanning, details of shunt revision, and cause of shunt malfunction were collected. The authors found that SSFSE MR imaging is a sufficient, radiation-free diagnostic alternative to CT scanning that minimizes movement artifact and duration of scanning and eliminates the need for sedation.
In light of these findings, the authors propose that quick-brain MR imaging replace CT scanning as the diagnostic modality of choice in examining and following shunt-treated patients because it offers significant advantages.

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    • "It appears reasonable to keep X-ray imaging to a minimum and MRI should be preferred to CT whenever possible [90]. MRI poses a different problem in infants who require sedation, even with specific quick sequences [91]. The practice of routine shunt series is based on the possibility of asymptomatic disruption or migration preceding overt shunt malfunction [82], and its yield has been evaluated at 1.4% [92]. "
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    ABSTRACT: The outcome of pediatric hydrocephalus, including surgical complications, neurological sequelae and academic achievement, has been the matter of many studies. However, much uncertainty remains, regarding the very long-term and social outcome, and the determinants of complications and clinical outcome. In this paper, we review the different facets of outcome, including surgical outcome (shunt failure, infection and independence, and complications of endoscopy), clinical outcome (neurological, sensory, cognitive sequels, epilepsy), schooling and social integration. We then provide a brief review of the English-language literature and highlighting selected studies that provide information on the outcome and sequelae of pediatric hydrocephalus, and the impact of predictive variables on outcome. Mortality caused by hydrocephalus and its treatments is between 0 and 3%, depending on the duration of follow-up. Shunt event-free survival (EFS) is about 70% at one year and 40% at ten years. The EFS after endoscopic third ventriculostomy (ETV) appears better but likely benefits from selection bias and long-term figures are not available. Shunt infection affects between 5 and 8% of surgeries, and 15 to 30% of patients according to the duration of follow-up. Shunt independence can be achieved in 3 to 9% of patients, but the definition of this varies. Broad variations in the prevalence of cognitive sequelae, affecting 12 to 50% of children, and difficulties at school, affecting between 20 and 60%, attest of disparities among studies in their clinical evaluation. Epilepsy, affecting 6 to 30% of patients, has a serious impact on outcome. In adulthood, social integration is poor in a substantial number of patients but data are sparse. Few controlled prospective studies exist regarding hydrocephalus outcomes; in their absence, largely retrospective studies must be used to evaluate the long-term consequences of hydrocephalus and its treatments. This review aims to help to establish the current state of knowledge and to identify conflicting data and unanswered questions, in order to direct future studies.
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