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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Postoperative evaluation after VP-Shunt Operation using low dose CT vs conventional imaging using cCT and X-ray of skull, thorax and abdomen

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  • Fadi Awad - Neurochirurgie, BKH GÜnzburg, Günzburg, Deutschland, Postoperative evaluation after VP-Shunt Operation using low dose CT vs conventional imaging using cCT and X-ray of skull, thorax and abdomen, F. Awad, A. Pala, M. Braun, B.Schmitz, C. Wirtz, J.Coburger
  • A. Pala - Neurochirurgie, BKH GÜnzburg, Günzburg, Deutschland, Postoperative evaluation after VP-Shunt Operation using low dose CT vs conventional imaging using cCT and X-ray of skull, thorax and abdomen, F. Awad, A. Pala, M. Braun, B.Schmitz, C. Wirtz, J.Coburger
  • M. Braun - Neurochirurgie, BKH GÜnzburg, Günzburg, Deutschland, Postoperative evaluation after VP-Shunt Operation using low dose CT vs conventional imaging using cCT and X-ray of skull, thorax and abdomen, F. Awad, A. Pala, M. Braun, B.Schmitz, C. Wirtz, J.Coburger
  • B. Schmitz - Neurochirurgie, BKH GÜnzburg, Günzburg, Deutschland, Postoperative evaluation after VP-Shunt Operation using low dose CT vs conventional imaging using cCT and X-ray of skull, thorax and abdomen, F. Awad, A. Pala, M. Braun, B.Schmitz, C. Wirtz, J.Coburger
  • C. Wirtz - Neurochirurgie, BKH GÜnzburg, Günzburg, Deutschland, Postoperative evaluation after VP-Shunt Operation using low dose CT vs conventional imaging using cCT and X-ray of skull, thorax and abdomen, F. Awad, A. Pala, M. Braun, B.Schmitz, C. Wirtz, J.Coburger
  • J. Coburger - Neurochirurgie, BKH GÜnzburg, Günzburg, Deutschland, Postoperative evaluation after VP-Shunt Operation using low dose CT vs conventional imaging using cCT and X-ray of skull, thorax and abdomen, F. Awad, A. Pala, M. Braun, B.Schmitz, C. Wirtz, J.Coburger

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 146

doi: 10.3205/17dgnc709, urn:nbn:de:0183-17dgnc7097

Published: June 9, 2017

© 2017 Awad et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: An operative implantation of VP-Shunt system is the most common used therapy for different types of hydrocephalus. Postoperative cCT and X-ray of head, thorax and abdomen are commonly used to evaluate the position of the VP-Shunt components (ventricular catheter, abdominal catheter, valve position and connection Points). Since few months low dose CT (of head, thorax and abdomen) emerged as a novel evaluation method. Our study aims to compare between the 2 modalities (Comparing the total CT dose used and the ability to assess the different VP-Shunt components but also of the postoperative mechanical complications)

Methods: Comparing between 2 groups of patients in a retrospective study including adult patients older than 18 years old after an operative implantation of a VP-Shunt system. The 1st group is composed of a total of 44 postoperative low dose CTs and the 2nd group is composed of postoperative 27 cCts accompanied by Xray of head, thorax, and abdomen. The comparison is regarding the effective dose of CT in mSv, the quality of both modalities (evaluated on a scale from 1 to 5 while 1 is not assessable and 5 is assessable with highest accuracy) to show the position of ventricular catheter, abdominal catheter, valve position, the pressure level of the valve and the possible dislocation or disconnection of the shunt system.

Results: The mean dose of the low dose CT was calculated as effective dose of 6.666 mSv while the mean dose of the conventional cCT was calculated as effective dose of 10.984 mSv. To be taken in consideration, that the patients of the 2nd group are exposed in addition the the CT to X-ray with additional radiation exposure. The standard estimates of the X-ray doses equal 0.13 mSv, so that the mean effective dose of the 2nd group is calculated as 11.078 mSv.

Using the low dose CT we could diagnose 6 catheter dislocations out of total 6 dislocations and 1 catheter disconnection out of 1 disconnection with high image quality and high accuracy with a mean on the measuring scale of 5/5. In all cases of the 1st group was the pressure level of the valve not measurable with the mean on the evaluation scale of 1/5. In contrary the 2nd group had the advantage of recording the pressure level of the valve with a mean from 5/5.

Conclusion: Using low dose CT to evaluate the postoperative Position of the VP Shunt system could replace the traditionally used method using CT and X-ray, offering high quality, high accuracy and lower dose exposition(Effective dose of 6.666 mSv against 11.078 mSv). If pressure level of the valve is clinically important, an additional lateral X-Ray of the skull is necessary (Standard effective dose 0.01 mSv).