1. Radionuclide Shuntography for Evaluation of V-P shunt in Hydrocephalus
Dr ZM Jawa MBBS, MSc, FMCR, FCNP, FEBNM
Senior Consultant Nuclear Medicine Physician
European Board Certified in Nuclear Medicine
Abuja, NIGERIA

2. Address Introduction to shuntography Hydrocephalus and Shuntograms
Malfunction
Available techniques to investigate shunts
Radionuclide shuntography technique,interpretations, complications, suboptimal scan
Our experiences

3. Introduction
Radionuclide shuntography is a safe and simple method of determining CSF shunt patency and analyze change in CSF flow( functional study)
Shunts are permanent treatment option for patient with Hydrocephalus
V-P, V-Pleural, V-atrial, V-jugular, V- gallbladder.

4. Hydrocephalus Prematurity (posthaemorrhagic hydrocephalus) Meningitis
Congenital e.g. encephalocele
Head trauma
Brain tumours

6. Ventriculoperitoneal Shunt
Permanent curative options for hydrocephalus
Surgical procedure is invasive and not readily available, requires expertise
Shunt tubes are expensive
There is significant improvement in the quality of life of patients with hydrocephalus post shunt.
Regular assessment of shunt for function is important.

7. Types of CSF shunts

8. Ventriculo-Peritoneal Shunt Tube
3 Parts
ventricular catheter
Reservoir( Valve)
Distal catheter

9. Reservour

14. Malfunction Infection, usually occurs within 3mt postoperative
Mechanical failure
Inflammatory debris
Fractures of tube
Failure of valve system of reservoir

15. Clinical Presentations of Malfunction V-P shunt tube
Progressive head enlargements
Shuntalgia syndrome, Headache, pain and tenderness on reservoir site, muscular weakness, urinary incontinence

17. investigations Plain Xrays CT and MRI Intracranial pressure monitor
Transfotanelle Ultrasound
Radionuclide shuntography

18. Technique Under strict aseptic technique
Using insulin syringe, tilted at degrees at 1-2cm below the reservoir
Withdraw CSF ,Inject normal saline to ascertain that needle is insitu
Inject radiopharmaceuticals; Tc99m DPTA
Acquire dynamic and static images.
After care: very important

29. Complications Puncher of reservoir Extravasations of Radioactivity
Bleeding
Infection
CSF pseudocyst

30. Suboptimal study Uncooperative child Extravasation
Bleeding, early Tc99m uptake in stomach
Older children, inadequate volume of Radioactivity

33. Our Experience; Total of 56 patients, 32 males, 24 females
Age range, 5-11yrs
Results
Normal functioning shunt:
Total blocked tube(Mechanical):
Partial block tube( infection or debris):29
Inconclusive or suboptimal:

34. Conclusion
Radionuclide shuntography is a simple, cheap, safe and non-invasive method of evaluating CSF shunts.
No existing protocol for RS but critical attention to details ,observation of strict aseptic technique and close collaboration between the Nuclear medicine physician, Pediatricians and Neurosurgeons would improve diagnostic accuracy.

35. Attention to details and precision

36. Conclusion
About 45% of our patients with suspected V-P tube malfunction had partial blockage.
Patients who are diagnosed with a partial tube blockage will require only flushing of the tube and antibiotics treatment, while mechanically block tube will require replacement.
This distinction is critical considering the cost of replacement of tube and manpower time for surgery.

37. Thank you