Senior Consultant Nuclear Medicine Physician European Board Certified in Nuclear Medicine Abuja NIGERIA Radionuclide Shuntography for Evaluation of VP shunt in Hydrocephalus Introduction to shuntography ID: 807034
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Dr ZM Jawa MBBS, MSc, FMCR, FCNP, FEBNMSenior Consultant Nuclear Medicine PhysicianEuropean Board Certified in Nuclear MedicineAbuja, NIGERIA
Radionuclide Shuntography for
Evaluation
of V-P shunt in
Hydrocephalus
Slide2Introduction to shuntographyHydrocephalus and ShuntogramsMalfunctionAvailable techniques to investigate shuntsRadionuclide shuntography
technique,interpretations
, complications, suboptimal scanOur experiences
Address
Slide3Radionuclide shuntography is a safe and simple method of determining CSF shunt patency and analyze change in CSF flow( functional study)Shunts are permanent treatment option for patient with HydrocephalusV-P, V-Pleural, V-atrial, V-jugular, V- gallbladder.
Introduction
Slide4Prematurity (posthaemorrhagic hydrocephalus)MeningitisCongenital e.g. encephalocele
Head trauma
Brain tumours
Hydrocephalus
Slide5Slide6Permanent curative options for hydrocephalusSurgical procedure is invasive and not readily available, requires expertiseShunt tubes are expensiveThere is significant improvement in the quality of life of patients with hydrocephalus post shunt.
Regular assessment of shunt for
function is important.
Ventriculoperitoneal Shunt
Slide7Types of CSF shunts
Slide83 Parts ventricular catheterReservoir( Valve) Distal catheter
Ventriculo
-Peritoneal Shunt Tube
Slide9Reservour
Slide10Slide11Slide12Slide13Slide14Infection, usually occurs within 3mt postoperativeMechanical failureInflammatory debrisFractures of tube
Failure of valve system of reservoir
Malfunction
Slide15Progressive head enlargementsShuntalgia syndrome, Headache, pain and tenderness on reservoir site, muscular weakness, urinary incontinence
Clinical Presentations of Malfunction V-P shunt tube
Slide16Slide17Plain XraysCT and MRIIntracranial pressure monitorTransfotanelle Ultrasound
Radionuclide shuntography
investigations
Slide18Under strict aseptic techniqueUsing insulin syringe, tilted at 30-45 degrees at 1-2cm below the reservoir Withdraw CSF ,Inject normal saline to ascertain that needle is insituInject radiopharmaceuticals; Tc99m DPTA
Acquire dynamic and static images.
After care: very important
Technique
Slide19Slide20Slide21Slide22Slide23Slide24Slide25Slide26Slide27Slide28Slide29Puncher of reservoirExtravasations of RadioactivityBleedingInfectionCSF pseudocyst
Complications
Slide30Uncooperative childExtravasationBleeding, early Tc99m uptake in stomachOlder children, inadequate volume of Radioactivity
Suboptimal study
Slide31Slide32Slide33Total of 56 patients, 32 males, 24 femalesAge range, 5-11yrsResults
Normal functioning shunt: 18
Total blocked tube(Mechanical): 7
Partial block tube( infection or debris):29
Inconclusive or suboptimal: 2
Our Experience;
Slide34Radionuclide shuntography is a simple, cheap, safe and non-invasive method of evaluating CSF shunts.No existing protocol for RS but critical attention to details ,observation of strict aseptic technique and close collaboration between the Nuclear medicine physician, Pediatricians and Neurosurgeons would improve diagnostic accuracy.
Conclusion
Slide35Attention to details and precision
Slide36About 45% of our patients with suspected V-P tube malfunction had partial blockage.Patients who are diagnosed with a partial tube blockage will require only flushing of the tube and antibiotics treatment, while mechanically block tube will require replacement.
This
distinction is critical considering the cost of replacement of tube and manpower time for surgery.
Conclusion
Slide37Thank you