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. 2023 Aug;39(8):1995-1997.
doi: 10.1007/s00381-023-05984-3. Epub 2023 May 10.

Adjustable shunts and proton therapy: a magnetic combination

Sofie Dietvorst  1 , Kenneth Poels  2 , Karen Van Beek  2 , Ronald Peeters  3 , Philippe De Vloo  4
Affiliations

Adjustable shunts and proton therapy: a magnetic combination

Sofie Dietvorst et al. Childs Nerv Syst. 2023 Aug.

Abstract

Objective: Due to evidence for proton beam therapy (PBT) in pediatric central nervous system (CNS) tumors, compact proton therapy systems became commercially available to allow better integration in a hospital setting. However, these systems have a non-zero magnetic field at the level of the patient. Often, these patients have a cerebrospinal fluid shunt, and most of them are adjustable through a magnet. Whether the induced magnetic fields could interfere with adjustable shunts is unknown.

Methods: In the first five CNS tumor patients with adjustable shunts who underwent PBT, the shunt setting was controlled before, during, and after treatment with PBT. Additionally, we used an ex vivo adjustable shunt to check if the settings could be altered by the magnetic field.

Results: We did not observe unintentional changes in shunt settings in vivo during treatment. In ex vivo testing, the shunt settings were altered directly cranial to the exit window of PBT due to the magnetic field.

Conclusion: Although we did not observe any shunt setting alteration during PBT in this small cohort, caution is warranted. Given the lack of high-volume data, there should be a low threshold for checking the shunt setting at the end of PBT therapy or in a symptomatic patient.

Keywords: Adjustable cerebrospinal fluid shunt; Magnet; Magnetic field; Proton beam therapy.

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