Imaging of the Ventriculoperitoneal Shunt-Related Complications in Infants and Children With Hydrocephalus

ABSTRACT

PURPOSE: To evaluate the frequency and imaging findings of various ventriculo-peritoneal shunt-relatedcomplications in pediatric patients with hydrocephalus. MATERIALS AND METHODS: We retrospectively reviewed 246plain radiographs, three shuntograms, 53 ultrasounds, 133 CT scans, and 24 MR images obtained before and after theventriculo-peritoneal shunt procedure in 33 pediatric patients with hydrocephalus. Using preoperative images, theetiology of the hydrocephalus was assessed. Changes in the size and shape of the ventricles, the location andcontinuity of shunt apparatus, and the presence of any abnormal enhancement, hemorrhage, edema or tissue loss, orother findings of complications, were analyzed on postoperative images; the frequency and imaging findings ofshunt-related complications such as shunt malfunction, infection, hemorrhage or isolated ventricle, andcomplications caused by overdrainage, were thus evaluated. The frequency of such complications was analyzedaccording to the etiology of the hydrocephalus, and in addition, medical records were reviewed and correlated withimaging findings. RESULTS: In 18 of the 33 patients(54%), a total of 31 complications was detected. These werepresent in four of five cases (80%) of hydrocephalus caused by meningitis and ventriculitis, seven of twelve (58%)intraventricular hemorrhage, two of four (50%) unknown cases, three of nine (33%) congenital malformations, one oftwo (50%) tumors, and one (100%) congenital infection. Shunt malfunction was most common(n=15), and wasaccompanied by findings of enlarged ventricles, periventricular and peritubal edema, and abnormal location of theshunt tube. Symptoms and signs of increased intracranial pressure were also noted. Subdural hemorrhage andinfection were present infour cases each;findings of infection were enhancement of the ventricular wall, meninges,and parenchyma, as well as sonographically noted intraventricular septation and increased ventricular wall echo.Isolated lateral ventricle (n=4) or 4th ventricle (n=1) was persistently distended in spite of the presence of ashunt tube within the other ventricle. Collapsed ventricles, thick calvarium, and symptoms of increasedintracranial pressure were helpful in the diagnosis of slit ventricle syndrome(n=1). Immediate postoperativeintraventricular and parenchymal hemorrhage were noted in one case each. CONCLUSION: Shunt-related complicationswere found on postoperative images in 54% of pediatric patients with hydrocephalus; the frequency was highest incases of hydrocephalus caused by infection. Shunt malfunction occurred most frequently and each complication hadvarious imaging findings. For the diagnosis of post-operative shunt-related complication, continuous follow-upstudies are therefore necessary.