A ventricular shunt is a small plastic tube, surgically implanted, that drains excess fluid. According to the National Cancer Institute, this drain drains fluid either directly through the skull (external drain) or to another part of the body, often into the abdomen (internal drain), which relieves pressure on the brain. Children receive ventricular leads for hydrocephalus, a condition in which brain fluid does not drain or reabsorb properly due to brain hemorrhages, tumors or other causes.
Ventricular bypass surgery: Symptoms are often nonspecific.
“Experts estimate that nearly 30% of ventricular leads fail, break, move or become blocked within two years of placement, and 5% fail every year thereafter.”This was stated by researchers from the Hospital for Sick Children in Toronto (Canada). When a patient presents to the emergency department for potential shunt failure, symptoms are often nonspecific, including headache, vomiting, and fatigue. Lead failure is life-threatening, and children with it typically undergo several CT and MRI scans a year, subjecting themselves to excessive radiation and sedation. The accumulation of fluid causes swelling of the optic nerve sheath, which can be measured using an ultrasound of the eye.
53% of young participants had congenital hydrocephalus.
In a recent study, a Canadian team wanted to know whether changes in the diameter of the optic nerve, when a patient is symptomatic and when they are healthy, could determine whether the shunt is blocked. For the purposes of her work, she examined 76 pairs of scans that were performed on 58 asymptomatic children who had undergone bypass surgery. The average age of young patients was about 7 years, and 65.8% were boys. According to the data, 53% of children had congenital hydrocephalus, 21% had a tumor, 53% were hospitalized and 21% were admitted to the operating room.
Changing optic nerve diameter to detect ventricular shunt failure
The results, which were presented at the 2024 Academic Pediatric Societies meeting May 2-6 in Toronto, showed that change in optic nerve diameter was significantly associated with lead dysfunction, while change in optic disc height was not. Changes in optic nerve diameter have also been associated with increased ventricular size, periventricular interstitial edema, or effacement of cortical sulci. “The lack of change in optic nerve head height in shunt patients should not provide undue confidence. Further research is needed to determine whether changes in optic nerve diameter make a positive contribution to the clinic’s prediction rules for shunt failure.”the authors concluded.
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