The use of transcutaneous thermal convection analysis to assess shunt function in the pediatric population.
BACKGROUND
The diagnosis of shunt malfunction is largely made by subjective clinical history and assessment in association with neurodiagnostic imaging.


OBJECTIVE
: To evaluate the use of a transcutaneous thermal convection device for the diagnosis of shunt malfunction.


METHODS
We present the results of a trial of a commercially available device under an Institutional Review Board-approved protocol. All patients had neurodiagnostic studies that defined their shunt function at the time of transcutaneous thermal convection measurement. Thirty-seven shunts were studied in 35 patients. To be included, patients had to be between 0 to 18 years of age, had to be due within a 3-month period for routine follow-up evaluations, and had to have neurodiagnostic imaging (computed tomography or magnetic resonance imaging) as part of this visit and a shunt series. All patients were seen in routine follow-up, and none had clinical symptoms of shunt malfunction.


RESULTS
Three patients had fractured shunts. The remaining 32 patients had functioning shunts as determined by clinical criteria, computed tomography or magnetic resonance imaging scans, and, when appropriate, a shunt series. In these remaining patients, flow was initially confirmed in only 40%. After some filtering of the data, this was increased to 51%. Although these results are disappointing, they outline the current issues with the technique and the state of its utility and point to the need for further refinement.


CONCLUSIONS
Our current research suggests that cerebrospinal fluid flow as detected by thermoconvection analysis is not a reliable indicator of shunt function in the pediatric population.
Department of Neurosurgery and Brain Repair, Division of Pediatric Neurosurgery, University of South Florida, Tampa, Florida 33606, USA.
Arthur E
AE
Marlin
Sarah J
SJ
Gaskill
D000293:Adolescent; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D019586:Intracranial Hypertension / Q000175:diagnosis* / Q000517:prevention & control / Q000601:surgery; D008297:Male; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D013525:Surgical Instruments / Q000009:adverse effects / Q000592:standards*; D013814:Thermal Conductivity; D013821:Thermometers / Q000592:standards*