Assessment of Ventriculoperitoneal Shunt Function Using Ultrasound Characterization of Valve Interface Oscillation as a Proxy

Objective Ventricular shunts are a mainstay of hydrocephalus treatment, but the detection of its clinical failure often relies on circumstantial evidence. A direct, non-interventional method for reliably evaluating cerebrospinal fluid (CSF) function does not exist due to the difficulty of measuring in vivo flow characteristics. The objective of this study is to apply a novel method of ultrasound monitoring to characterize the oscillation observed during pulsatile CSF flow and failure states in an in vitro and cadaveric model. Method In this proof-of-concept report, ultrasound is utilized to noninvasively monitor the shunt valve and characterize its mechanical response to different flow conditions. In vitro and in situ testing was carried out by running deionized water through a ventriculoperitoneal shunt (VPS) system using a pulsatile flow generator to replicate the flow rates expected in vivo. Different flow conditions were then tested: no flow, normal flow, proximal obstruction, and distal obstruction. Ultrasound data taken from the pressure relief valve were analyzed to determine differences in the displacement of valve components over time between flow states. Results Displacement patterns of the four different flow conditions were determined by directly tracking the changes from the M-mode plots. Each pattern was found to be distinct and repeatable with statistically significant results found when comparing the normal flow condition to distal and proximal obstruction cases. Conclusions Each of the flow conditions was found to have a distinct displacement profile, demonstrating that ultrasound imaging of the shunt valve can be used to accurately differentiate between flow and failure conditions. Ultrasound monitoring may be a promising adjunct approach in determining the need for surgical shunt exploration.