Distal Ventriculoperitoneal Shunt Obstruction

            Male 42 year old with hydrocephalus secondary to  hemangioblastoma of the cerebellum, operated on several times. He was treated as of 7 years with a ventriculo-peritoneal shunt.  Presents clinically with headache and vomitus in recent weeks suspecting valve malfunctioning. He was referred for shunt assessment. Images obtained in the first 30 min after injecting a small bolus of 99m Tc in the pump reservoir (arrow) show flow into the distal device up to the peritoneal cavity, but no free diffusion was noted. Delay image displays a collection of CSF in the peritoneum (arrow). Due to absorption of pertechnectate, activity in the stomach is also visualized in the 24 h image.  No reflux retrograde of tracer into the lateral ventricles (1).

            According to Vernet et al., the shuntogram is a useful procedure in the management of patients presenting with shunt-related problems. For consideration as a normal result, a shuntogram must exhibit ventricular reflux, the shunt system must be entirely visualized and the isotope must diffuse uniformly in the peritoneal cavity (2).

References:

1   Thom AF et al. Medicina Nuclear en la Hidrocefalia del Adulto, p: 491-497 in: Medicina Nuclear Aplicaciones Clínicas. Eds: I. Carrio - P. González. Editorial Masson, Barcelona España, 2003.

2   Vernet O, Farmer JP, Lambert R, Montes JL. Radionuclide shuntogram: adjunct to manage hydrocephalic patients. J Nucl Med. 1996 Mar;37(3):406-10.

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