Neurological Surgery| February 01 2002 Periodic Surveillance CT to Detect Asymptomatic CSF Shunt Failure AAP Grand Rounds (2002) 7 (2): 17–18. https://doi.org/10.1542/gr.7-2-17 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Periodic Surveillance CT to Detect Asymptomatic CSF Shunt Failure. AAP Grand Rounds February 2002; 7 (2): 17–18. https://doi.org/10.1542/gr.7-2-17 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: cerebrospinal fluid shunts, surveillance, medical Source: Liptak GS, Bolander HM, Langworthy K. Screening for ventricular shunt function in children with hydrocephalus secondary to meningomyelocele. Pediatr Neurosurg. 2001;34:281–285. The prevalence of hydrocephalus in the general population is probably at least 2 per 1000,1 and most patients with hydrocephalus require CSF shunts. In the early 1990s, there were an estimated 40,000 hospital discharges annually after CSF shunt-related procedures.2 CSF shunts fail at a rate of 30 to 40% in the first year after insertion and at roughly 5% per year subsequently.3 These failure statistics are surprisingly uniform from institution to institution and famously resistant to “improvements” in shunt valve design.4 Liptak et al from the University of Rochester Medical Center, Rochester, New York, attempted to answer an important practical question of whether there is value in periodic computed tomographic (CT) surveillance for asymptomatic shunt failure. Although their report is retrospective, their clinical practice during the epoch of the study was protocol-driven. They analyzed only patients with meningomyelocele, historically the most common etiology for hydrocephalus, thereby eliminating another source of variability. The protocol required 1 CT scan per year after the first year of life and treatment of all asymptomatic patients with CSF shunt failure (not a universal neurosurgical practice in North America). One hundred twelve patients received a total of 1,763 surveillance CT scans over a 12.2-year period. There were 255 episodes of shunt failure among 96 patients. The presentation of shunt failure was on the basis of symptoms in 76% of instances, physical signs in 15%, and CT findings alone in 8%. Among patients whose shunts had been functioning for more than 1 year before failure, 14% of failures presented with CT findings alone. Multiple regression analysis indicated no effect of mode of diagnosis on length of hospital stay. Logistic regression indicated no effect of mode of diagnosis on frequency of complications. The authors’ experience does not support CT scan surveillance of asymptomatic patients. The authors asked whether asymptomatic patients detected by surveillance CT scanning have shorter hospital stays and fewer complications than other patients with CSF shunt failure, and the answer was “no.” They asked, but did not answer, the question of whether surveillance scanning reduces cognitive morbidity from symptomatic shunt failure. They might have asked several other questions as well, such as, “Did their practice of surveillance scanning reduce the incidence of out-of-hospital death from shunt failure?” That they observed no out-of-hospital deaths among their meningomyelocele patients over a 12-year period is notable.5 Did the availability of current, baseline surveillance imaging expedite the evaluation of subsequent, symptomatic episodes of CSF shunt failure? The authors, all pediatricians, did not consider this qualitative and distinctly neurosurgical perspective. Did the aggressive treatment of asymptomatic shunt failure reduce comorbidity from syringomyelia? Syringomyelia is prevalent among patients with meningomyelocele and is often asymptomatic, but it can progress unpredictably to cause scoliosis and other neurological disabilities. Effective shunt treatment of hydrocephalus may minimize the risk of symptomatic progression of syringomyelia.... You do not currently have access to this content.