MBBS MSc FMCR FCNP FEBNM Senior Consultant Nuclear Medicine Physician European Board Certified in Nuclear Medicine Abuja NIGERIA Radionuclide Shuntography for Evaluation of VP shunt in ID: 582352
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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
HydrocephalusSlide2
Introduction to shuntographyHydrocephalus and ShuntogramsMalfunctionAvailable techniques to investigate shuntsRadionuclide shuntography
technique,interpretations
, complications, suboptimal scanOur experiences
AddressSlide3
Radionuclide 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.
IntroductionSlide4
Prematurity (posthaemorrhagic hydrocephalus)MeningitisCongenital e.g. encephalocele
Head trauma
Brain tumours
HydrocephalusSlide5Slide6
Permanent 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 ShuntSlide7
Types of CSF shuntsSlide8
3 Parts ventricular catheterReservoir( Valve) Distal catheter
Ventriculo
-Peritoneal Shunt TubeSlide9
Reservour Slide10Slide11Slide12Slide13Slide14
Infection, usually occurs within 3mt postoperativeMechanical failureInflammatory debrisFractures of tube
Failure of valve system of reservoir
MalfunctionSlide15
Progressive head enlargementsShuntalgia syndrome, Headache, pain and tenderness on reservoir site, muscular weakness, urinary incontinence
Clinical Presentations of Malfunction V-P shunt tubeSlide16Slide17
Plain XraysCT and MRIIntracranial pressure monitorTransfotanelle Ultrasound
Radionuclide shuntography
investigationsSlide18
Under 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
TechniqueSlide19Slide20Slide21Slide22Slide23Slide24Slide25Slide26Slide27Slide28Slide29
Puncher of reservoirExtravasations of RadioactivityBleedingInfectionCSF pseudocyst
ComplicationsSlide30
Uncooperative childExtravasationBleeding, early Tc99m uptake in stomachOlder children, inadequate volume of Radioactivity
Suboptimal studySlide31Slide32Slide33
Total 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; Slide34
Radionuclide 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.
ConclusionSlide35
Attention to details and precisionSlide36
About 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.
ConclusionSlide37
Thank you