1	Imaging of ‘Treated’ Hydrocephalus: Documentation of Function and Malfunction Christine P. Chao, MD Alice Patton, MD Christopher Zaleski, MD
2	"To describe the systematic evaluation..." To describe the systematic evaluation of the ‘symptomatic’ adult and pediatric population who have been treated for hydrocephalus. To illustrate the imaging appearance of various causes of ‘shunt’ malfunction
3	"Increase in cerebrospinal fluid (..." Increase in cerebrospinal fluid (CSF) volume within the ventricular system, relative to the ‘baseline’ in an individual who is ‘symptomatic’ for increase in intracranial pressure
4	"CSF production by" CSF production by Choroid plexus: within the lateral, 3^rd and 4^th ventricles CSF circulation, from the Lateral ventricles, through the foramen of Monro 3^rd ventricle, through the aqueduct of Sylvius 4^th ventricle, exiting the foramen of Magendie and Luschka, into the subarachnoid space CSF absorption, by Arachnoid granulation at the superior sagittal sinus
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7	"Insertion of ‘shunts’" Insertion of ‘shunts’ Diversion of CSF flow from the ventricular system into another body cavity: Peritoneum (Fig. 1) Right atrium (Fig. 2) Pleural cavity (Fig. 3) Gallbladder (Fig. 4) Diversion of CSF from the sub arachnoid space into the peritoneal cavity, as lumbo- peritoneal shunt (Fig. 5) Diversion from the ventricular system into the sub arachnoid space, as in 3^rd ventriculostomy
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14	"Symptoms" Symptoms Headache Nausea and vomiting Abdominal pain Fever Signs Head circumference Respiratory distress Abdominal distension NON-SPECIFIC
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18	"Fig." Fig. 8 VENTRICULAR ENLARGEMENT 33 week gestation female infant US on day 4 of life demonstrates grade 3 IVH Follow-up US at 8 month of life, shows progressive ventricular enlargement
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36	"Shunt tubing generally silastic and..." Shunt tubing generally silastic and impregnated with barium to facilitate detection at radiography Shunt systems may have radiolucent tubing or valves; thus, important to compare with previous radiographs Development of fibrous tract around shunt catheter may continue to allow shunt function despite disconnection Fractured shunt fragments may be removed surgically or left in place
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60	"Clinical presentation and findings may..." Clinical presentation and findings may be non-specific The diagnostic accuracy for shunt malfunction may be improved with the availability of post-surgical asymptomatic ‘baseline’ cross-sectional imaging Systematic multi-modality evaluation of shunt position, continuity, and patency include the use of US, CT, MR, and scintigraphy Imaging workup is crucial in allowing prompt diagnosis of shunt malfunction and/or associated complications and may decrease morbidity
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