title: Use of transcranial real-time ultrasonography for programming a shunt valve system.
abstract: For patients who suffer from hydrocephalus that is difficult to treat because of impaired intracranial compliance, a programmable shunt system may be a helpful alternative. However, especially during the first weeks after implantation, many radiological follow-up studies are necessary to achieve the optimum pressure level. The authors present the case of a 7-year-old boy who suffered from posthemorrhagic hydrocephalus and did not respond to conventional shunt valve systems. After implantation of a programmable shunt system, achieving the optimum craniospinal fluid (CSF) pressure level was difficult because the symptoms of over- and under-drainage were similar. Using transcranial real-time ultrasonography for evaluation of the diameter of the intracranial CSF spaces, we were able to adjust the correct pressure level without long-term intracranial pressure monitoring or daily computed tomography, which otherwise would have been necessary because of the ambiguous symptomatology. Transcranial real-time ultrasonography (TCUS) displays an image of the intracranial parenchyma and CSF spaces through the intact temporal bone and is a valuable, serially applicable bedside monitoring technique for patients requiring close imaging follow-up.
authors.affiliation: Neurochirurgische Klinik und Poliklinik, Georg-August-Universität, Göttingen, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Mursch
authors.forename: J
authors.initials: J
authors.lastname: Behnke
authors.forename: H J
authors.initials: HJ
authors.lastname: Christen
authors.forename: E
authors.initials: E
authors.lastname: Markakis
mesh_terms: D002543:Cerebral Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology*; D002648:Child; D004200:Diseases in Twins; D004453:Echoencephalography / Q000295:instrumentation*; D004868:Equipment Failure; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D008297:Male; D019095:Point-of-Care Systems; D012086:Reoperation; D012984:Software; D017287:Ventriculoperitoneal Shunt / Q000295:instrumentation*