title: Infusion technique can be used to distinguish between dysfunction of a hydrocephalus shunt system and a progressive dementia.
abstract: In a deteriorating shunted patient with hydrocephalus, an investigation of shunt function is often performed to distinguish a dysfunctioning shunt from an aggravated condition of the disease. The paper illustrates how a lumbar cerebrospinal fluid (CSF) infusion method can be used to evaluate post-operative deterioration in a shunted patient in order to give the physician valuable support in the shunt revision decision. A 77-year-old man with hydrocephalus was treated operatively by the insertion of a CSF shunt. Owing to shunt failure, the shunt was revised twice during a 5 year period. Using a computerised infusion technique method, with two needles placed in the lumbar subarachnoid space, the CSF dynamic system was determined pre- and post-operatively with the functioning as well as the dysfunctioning shunts. The data were verified with a bench-test of the extirpated CSF shunt. There was a significant difference in conductance G between CSF systems with an open shunt and CSF systems with no shunt or an occluded shunt (deltaG= 38 mm3 s(-1) kPa(-1), p = 0.014, n= 7, ANOVA). CSF dynamics investigations, with and without a shunt, can give valuable clinical support in the management of a deteriorating hydrocephalus patient. With further development of the lumbar infusion method moving towards easy-to-use equipment, there is potential for widespread clinical use.
authors.affiliation: Department of Biomedical Engineering & Informatics, Umeå University Hospital, Umeå, Sweden. anders.eklund@vll.se
authors.forename: A
authors.initials: A
authors.lastname: Eklund
authors.forename: B
authors.initials: B
authors.lastname: Lundkvist
authors.forename: L-O D
authors.initials: LO
authors.lastname: Koskinen
authors.forename: J
authors.initials: J
authors.lastname: Malm
mesh_terms: D000368:Aged; D002555:Cerebrospinal Fluid / Q000378:metabolism; D002557:Cerebrospinal Fluid Shunts; D003704:Dementia / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004868:Equipment Failure; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007427:Intracranial Pressure; D008297:Male