The use of transcutaneous thermal convection analysis to assess shunt function in the pediatric population

Abstract

Background: The diagnosis of shunt malfunction is largely made by subjective clinical history and assessment in association with neurodiagnostic imaging.

Objective: : To evaluate the use of a transcutaneous thermal convection device for the diagnosis of shunt malfunction.

Methods: We present the results of a trial of a commercially available device under an Institutional Review Board-approved protocol. All patients had neurodiagnostic studies that defined their shunt function at the time of transcutaneous thermal convection measurement. Thirty-seven shunts were studied in 35 patients. To be included, patients had to be between 0 to 18 years of age, had to be due within a 3-month period for routine follow-up evaluations, and had to have neurodiagnostic imaging (computed tomography or magnetic resonance imaging) as part of this visit and a shunt series. All patients were seen in routine follow-up, and none had clinical symptoms of shunt malfunction.

Results: Three patients had fractured shunts. The remaining 32 patients had functioning shunts as determined by clinical criteria, computed tomography or magnetic resonance imaging scans, and, when appropriate, a shunt series. In these remaining patients, flow was initially confirmed in only 40%. After some filtering of the data, this was increased to 51%. Although these results are disappointing, they outline the current issues with the technique and the state of its utility and point to the need for further refinement.

Conclusion: Our current research suggests that cerebrospinal fluid flow as detected by thermoconvection analysis is not a reliable indicator of shunt function in the pediatric population.