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A recent study shows that using ophthalmic ultrasound in the emergency room can help quickly and safely detect children with brain drainage tube failure.
The research was presented at the Pediatric Academic Societies (PAS) 2024 meeting in Toronto.
A ventricular shunt is a small plastic tube that is surgically placed to remove excess fluid and reduce pressure on the brain. Ventricular shunts are used to treat hydrocephalus in children, a disorder caused by improper drainage or absorption of brain fluid from tumors, brain hemorrhage, and other sources. According to experts, within two years after implantation, about 30% of shunts rupture, become misplaced, or blocked, and an additional 5% fail every year thereafter.
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According to the researchers, when a patient goes to the emergency department for possible shunt failure, their symptoms are often non-specific, including headache, vomiting and fatigue. Shunt failure is life-threatening, and children with shunts typically undergo multiple computed tomography and magnetic resonance imaging scans per year, exposing them to excessive radiation and sedation. The accumulation of fluid causes swelling of the optic nerve sheath, which researchers can measure with ultrasound of the eye.
The study found that comparing the diameter of the optic nerve when a patient develops symptoms to the diameter when they recover can help determine whether a shunt is blocked.
Adrienne L., MD, research director of pediatric emergency medicine at The Hospital for Sick Children (SickKids). “The research team is interested in finding ways to reduce radiation exposure and accelerate the diagnosis of shunt failure in the emergency department,” said Davis, MD, MSc, FRCPC. And presenting writer. “The study uses the patients as their own controls by measuring the optic nerve when healthy and sick – a strategy that individualizes this test for each patient and recognizes that each patient with a shunt has shunt dependence and higher brain function. There is a unique degree of ability to tolerate pressure.”
Researchers studied ultrasounds of 76 pairs of eyes of about 60 children who came to the emergency department of a Toronto hospital with possible shunt failure. The researchers say that although the findings are promising, the results need to be further confirmed in a larger population of children with shunts across North America.
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