Detects flow in the cerebral shunts of hydrocephalus patients
Approach
Non-invasive
[edit on Wikidata]
ShuntCheck is a non-invasive diagnostic medical device which detects flow in the cerebral shunts of hydrocephalus patients. Neurosurgeons can use ShuntCheck flow results along with other diagnostic tests to assess shunt function and malfunction.[1]
Hydrocephalus is a condition in which cerebrospinal fluid (CSF) accumulates in the brain, potentially leading to brain damage and death. It is corrected by a shunt which drains excess CSF from the brain to the abdomen. Shunts fail, typically by obstruction – a life-threatening medical condition requiring the surgical replacement of the shunt. The symptoms of shunt failure are non-specific – headache, nausea, lethargy – so diagnostic tests must be conducted to rule in or rule out surgery. Current methods of diagnosing shunt malfunction, including CT Scan, MRI, radionuclide studies and shunt tap, have limitations and risks. These limitations and risks led to the development of ShuntCheck.[2][3][4][5][6][7][8][9][10][11][12][13][excessive citations]
ShuntCheck uses thermal dilution[14][15] to detect flow. The ShuntCheck sensor, a high-tech skin thermometer, is
placed over the shunt where it crosses the clavicle. The shunt, which lies just below the skin, is cooled with an ice pack placed “upstream” of the sensor. If CSF is flowing through the shunt, the cooled fluid will move “downstream” and the ShuntCheck sensor will detect a drop in temperature. Faster shunt flow results in greater temperature decreases. If the shunt is not flowing, the cooled fluid remains upstream and no temperature drop is recorded.[2]
The sensor is connected to a laptop or tablet computer running ShuntCheck software.
The sensor is connected to a laptop or tablet computer running ShuntCheck software. The computer analyzes the thermal data, determines “Flow Confirmed” or “Flow NOT Confirmed” and presents a time-temperature graph.
ShuntCheck Results Screen
Early clinical testing of ShuntCheck found that functioning shunts flow intermittently, which meant that a ShuntCheck reading of “Flow NOT Confirmed” did not necessarily indicate a shunt problem.[2][16] This discovery led to the development of the ShuntCheck Micro-Pumper, a handheld device which vibrates the shunt valve, generating a temporary increase in flow through patent, but not through obstructed, shunts. Micro-Pumper allows ShuntCheck to differentiate between temporarily non-flowing patent shunts and obstructed shunts.[1]
^ abcMadsen JR, et al, Evaluation of the ShuntCheck Noninvasive Thermal Technique for Shunt Flow Detection in Hydrocephalic Patients, Neurosurgery 68:198-205, 2011
^Brenner DJ, Hall EJ, Computed Tomography – An Increasing Source of Radiation Exposure, N Engl J Med 2007;357:2277-84
^Iskandar, B., et al., Pitfalls in the diagnosis of ventricular shunt dysfunction: radiology reports and ventricular size. Pediatrics, 1998. 101: p. 1031-1036.
^Forrest, D. and D. Cooper, Complications of ventriculo-atrial shunts. J Neurosurg, 1968. 29: p. 506-512.
^Iskandar, B., et al., Death in shunted hydrocephalic children in the 1990s. Pediatr Neurosurg, 1998. 28: p. 173-176.
^Piatt, J., Physical examination of patients with cerebrospinal fluid shunt: is there useful information in pumping the shunt? Pediatrics, 1992. 89: p. 470-473.
^Noetzel, M. and R. Baker, Shunt fluid evaluation: risks and benefits in the evaluation of shunt malfunction and infection. J Neurosurg, 1984. 61: p. 328-332.
^Howman-Giles, R., et al., A radionuclide method of evaluating shunt function and CSF circulation in hydrocephalus. J Neurosurg, 1984. 61: p. 604-605.
^Vernet, O., et al., Radionuclide shuntogram; adjunct to manage hydrocephalic patients. J Nucl Med, 1996. 37: p. 406-410.
^Brendel, A., et al., Cerebrospinal shunt flow in adults: radionuclide quantitation with emphasis on patient position. Radiology, 1983. 149: p. 815-818.
^Pitteti R. 2007. Emergency department evaluation of ventricular shunt malfunction: is the shunt series really necessary? Pediatr. Emerg. Care 23: 137-141.
^Sood S, Canady AI, Harn, SD. 2000. Evaluation of shunt malfunction using shunt site reservoir. Pediatr. Neurosurg. 32: 180-186.
^Stein SC, Apfel S, A noninvasive approach to quantitative measurement of flow through CSF shunts. Technical note, J Neurosurg 1981 Apr,54(4):556-8
^Neff S, Measurement of flow in cerebrospinal fluid in shunts by transcutaneous thermal convection, J Neurosurg (Pediatrics 4) 103:366-373, 2005
^Marlin AE, Gaskill SJ, The Use of Transcutaneous Thermal Convection Analysis to Assess Shunt Function in the Pediatric Population, Neurosurgery 70:181-3, 2012
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