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Advanced Neurology

PERSPECTIVE ARTICLE
Shuntogram technique for diagnosing shunt

failure in patients with programmable valves: A
literature review and a case scenario

Taylor C. Stevenson , Maryam N. Shahin , Dominic A. Siler ,
Erin A Yamamoto , Christian G. Lopez Ramos , and Donald A. Ross*
Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon,
United States of America

Abstract
Diagnosing shunt patency is crucial in the neurosurgical care of patients with
shunted hydrocephalus. The shuntogram is a commonly used method to assess
patency, yet its utility in accurately diagnosing shunt failure remains inconsistent. In
this article, we examined studies on shuntograms performed in patients with fixed-
pressure valves to clarify the techniques used and establish criteria for interpretation.
We further reviewed conflicting evidence in the literature regarding the utility of
shuntograms and outlined our institution’s protocol in the context of programmable
valves. Studies included in this review detailed the following elements of shuntogram
techniques: patient age, indication for shunt failure assessment, positioning, skin
*Corresponding author:
Donald A. Ross preparation, imaging protocol, contrast agents, patency testing, criteria for negative
(rossdo@ohsu.edu) and positive results, troubleshooting shunt, and sensitivity and specificity of findings.
Citation: Stevenson TC, Selection criteria included vague symptoms of shunt malfunction in the presence
Shahin MN, Siler DA, of non-diagnostic imaging. Patients were typically positioned supine or recumbent,
Yamamoto EA, Ramos CGL, with skin prepared using iodine-based products. Shunts were accessed using a
Ross DA. Shuntogram technique
for diagnosing shunt failure in 23 – 25-gauge needle, observing cerebrospinal fluid pressure and aspirate. The
patients with programmable contrast agent most frequently used was 99m Tc-diethylene-triamine-pentaacetate,
valves: A literature review and although the exact volume injected was inconsistently reported. Imaging protocols
a case scenario. Adv Neurol.
2024;3(4):4180. were not standardized, with delayed imaging intervals usually ranging from 9 to
doi: 10.36922/an.4180 20 min. Failure criteria for shuntograms varied significantly, with limited guidance on
follow-up interventions or troubleshooting. Notably, there was no mention of shunt
Received: July 9, 2024
reprogramming during these studies. This review highlights the significant variability
Accepted: September 20, 2024 in shuntogram techniques and outcomes. We present our institution’s protocol and
Published Online: November 19, a case scenario demonstrating successful implementation. With proper techniques
2024 and protocolization, shuntograms hold the potential as a valuable resource for
Copyright: © 2024 Author(s). accurately diagnosing shunt patency.
This is an Open-Access article
distributed under the terms of the
Creative Commons Attribution Keywords: Shuntogram; Ventriculoperitoneal shunt; Technique; Shunt failure; Protocol;
License, permitting distribution, Cerebral shunt patency
and reproduction in any medium,
provided the original work is
properly cited.
Publisher’s Note: AccScience
Publishing remains neutral with 1. Introduction
regard to jurisdictional claims in
published maps and institutional Ventricular shunts for hydrocephalus are known in the literature to have a failure rate
1-3
st
affiliations. exceeding 30% in the 1 year and up to 81% within 12 years. While definitions of
Volume 3 Issue 4 (2024) 1 doi: 10.36922/an.4180