Is shunt series X-ray necessary before revision of obstructed ventriculoperitoneal shunt?

Abstract

Objectives The purpose of this study is to estimate whether routine preoperative shunt series (POSS) lead to clinically relevant new information, that helps in the management of ventriculoperitoneal shunt (VPS) obstruction, focusing on its role in diagnosing mechanical causes of shunt obstruction. Methods Retrospective review of 64 consecutive patients who underwent revision of obstructed VPS in the neurosurgery division, at King Saud University, Riyadh, Saudi Arabia, between June 2002 and December 2011, assessing the proportion and impact of abnormal findings in the POSS. Results Sixty-nine POSS were performed for 64 patients before revision of obstructed VPS. Their mean age was 11.8 years, and 25 patients among them were females. Seventeen (24.6%) POSS had abnormal finding, that was statistically significant (P = 0.005), and only 10 of them influenced the surgical technique or choice of therapeutic procedure (P = 0.0001). Positive findings were in the form of; broken/disconnected catheter (n = 4), intra-abdominal migration of peritoneal catheter (n = 4), coiled/extra-peritoneal distal catheter (n = 2), short peritoneal end (n = 1), and retained catheter/more than one shunt (n = 6). However, majority of shunt series (75.4%) were normal. Conclusion Routine shunt series X-ray alone is not a diagnostic tool for shunt malfunction, and POSS should be reserved for patients with proven shunt failure on CT or MRI scan. There was a significant impact of POSS on the operative decision for those undergoing revision for VPS obstruction. © 2014 Taibah University. Production and hosting by Elsevier Ltd. All rights reserved.