case presentation

1. D R . Y A S S E R A S I R I R 2
S U P E R V I S E D B Y :
D R . L I N A A B D U L S A M A D
Cerebrospinal (CSF) shunt
scintigraphy

2.  11 year-old male patient known case of cerebral palsy
, status post-VP shunt insertion , presented with
seizure and vomiting.

4.  18 year-old patient known case of cerebral palsy , VP
shunt malfunction, to rule out shunt obstruction

6.  8 year-old with history of shunt placement twice ,
presented with ? Malfunctioning /under functioning
shunt.

8.  What is a shunt patency study?
The shunt patency is a study to determine if
cerebrospinal fluid (CSF) is actually flowing through
the shunt system (valves and proximal and distal
catheters). By injecting a small volume (about 0.3 ml)
of a radiotracer into the shunt reservoir, the flow of
CSF through the catheters and valve can be measured.

9.  How does it differ from a shunt X-ray or CT Brain ?
While a shunt X-Ray can tell the settings of the shunt
and if there is a physical break in the catheters, and CT
scan can be used to evaluate ventricle size and the tube
position.
These studies cannot tell if cerebrospinal fluid (CSF) is
actually flowing through the shunt system.

10. The shunt system consists of a reservoir with a valve
placed beneath the soft tissues of the head, a proximal
(afferent) tubing line leading from one of the ventricles
to the reservoir, and a distal (efferent) tubing line
leading from the reservoir to the peritoneal cavity

11.  How is the test performed?
The patient is positioned lying down under the camera system.
The hair around the shunt reservoir is clipped or shaved.
The reservoir is punctured with a tiny needle.
A small amount of the patient’s own CSF is aspirated into a syringe.
A small amount (0.3ml) of radiotracer is injected through the needle
and flushed with the patient’s own CSF.
Pictures are taken every minute for 20 minutes to track the flow of the
radiotracer through the shunt system.
If no flow is observed the patient is asked to sit up and walk around
for 5-10 minutes before more pictures are taken. Rarely, delayed
pictures after 1-2 hours may be necessary.

12.  Radiopharmaceutical:
 (Tc-99m DTPA) [Preferred]
 Tc-99m Pertechnetate