A recent study presented at the Pediatric Academic Societies (PAS) 2024 Meeting in Toronto proposes the use of ocular ultrasound in the emergency room as a means to swiftly and safely identify children experiencing failure of their brain drainage tubes.
Ventricular shunts, small plastic tubes surgically inserted to alleviate brain pressure by draining excess fluid, are commonly employed in children to address hydrocephalus, a condition stemming from improper drainage or absorption of brain fluid due to factors like tumors or brain bleeds. Specialists note that within two years post-implantation, approximately 30% of shunts may malfunction due to breakage, displacement, or blockage, with an additional 5% failing annually thereafter.
Children suspected of shunt failure typically present with nonspecific symptoms such as headaches, vomiting, and fatigue when visiting the emergency department, according to researchers. Shunt failure poses a severe risk to life, prompting affected children to undergo multiple scans annually, including computed tomography and magnetic resonance imaging, exposing them to considerable radiation and sedation. Researchers have observed that fluid backup leads to swelling of the optic nerve sheath, a phenomenon detectable via eye ultrasound.
The study determined that comparing the optic nerve diameter during symptomatic and asymptomatic states can aid in identifying shunt blockages. Dr. Adrienne L. Davis, the pediatric emergency medicine research director at The Hospital for Sick Children (SickKids) and the study's lead author, emphasizes the research team's interest in reducing radiation exposure and expediting shunt failure diagnosis in emergency settings. By measuring optic nerve parameters under varying conditions for each patient, the study customizes the diagnostic approach, acknowledging the unique shunt dependence and brain pressure tolerance of each individual.
The research analyzed 76 pairs of eye ultrasounds from nearly 60 children presenting with suspected shunt failure at a Toronto hospital's emergency department. While the findings are promising, researchers stress the need for further validation in a larger cohort of children with shunts across North America.
