# Radionuclide Shunt Scintigraphy Technique in Diagnosing Ventriculoperitoneal Shunt Malfunction and Patency: A Case Study and Review of Literature

## TL;DR

This paper discusses using radionuclide scintigraphy to diagnose issues with ventriculoperitoneal shunts in hydrocephalus patients.

## Contribution

The study presents a case where radionuclide shunt scintigraphy successfully identified shunt patency and malfunction.

## Key findings

- Radionuclide scintigraphy confirmed a patent distal peritoneal catheter in the patient.
- The literature review highlights various non-invasive diagnostic methods for shunt malfunction.
- Prompt diagnosis using these methods allows targeted surgical correction.

## Abstract

Although cerebrospinal fluid (CSF) diversion through ventriculoperitoneal shunt insertion is a conventional treatment for hydrocephalus, shunt malfunction is a common complication, making its diagnosis critical. We report a patient with a background of congenital hydrocephalus and an in situ ventriculoperitoneal shunt (VPS) exhibiting worsening papilledema with raised lumbar puncture opening pressures, indicating a possible VPS malfunction. A review of the current diagnostic methods for VPS malfunction, focusing on radionuclide scintigraphy, was conducted in this case review. VPS radionuclide scintigraphy was successfully performed in our patient using intrathecal administration of Tc-99m diethylene-triamine-penta-acetic acid (DTPA) into the CSF shunt reservoir, facilitating tracer visualization. A review of the patient’s case notes and subsequent literature review identified several methods for diagnosing VPS malfunction to determine the correct shunt malfunction segment and respective corrective measures. VPS radionuclide scintigraphy in our patient confirmed a patent distal peritoneal catheter, although a transient proximal ventricular catheter blockage and malfunction remained a possibility. The literature review highlighted successful worldwide applications of substance dilution, thermal transfer, ultrasound, and Doppler techniques for diagnosing VPS malfunction with radionuclide shunt scintigraphy. Evaluating VPS function comprises various methods and is significantly important to prevent adverse consequences for the patient, allowing prompt revision surgery directed at the site of obstruction or malfunction. Hence, VPS malfunction diagnosis is vital for leading appropriate corrective measures, with radionuclide shunt scintigraphy functioning as a non-invasive method.