• Mustafa Q Hameed, David Zurakowski, Mark R Proctor, Stone Scellig S D SSD Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts., Benjamin C Warf, Edward R Smith, Liliana C Goumnerova, Marek Swoboda, Tomer Anor, and Joseph R Madsen.
• Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
• Neurosurgery. 2019 Aug 1; 85 (2): 240-249.

BackgroundWhile a noninvasive flow determination would be desirable in the diagnosis of cerebrospinal fluid shunt malfunction, existing studies have not yet defined a role for thermal flow detection.ObjectiveTo evaluate a revised test protocol using a micropumper designed to transiently enhance flow during thermal testing to determine whether thermal detection of flow is associated with progression to shunt revision surgery.MethodsEighty-two unique tests were performed in 71 shunts. The primary outcome, need for revision within 7 d of testing, was compared with results of micropumper-augmented thermal flow detection. Statistical analysis was based on blind interpretation of test results and raw temperature data recorded during testing.ResultsThe test was sensitive (73%) and specific (68%) in predicting need for revision, with 5.6-fold higher probability of revision when flow was not detected. Negative predictive value in our sample was 94.2%. The probability of not requiring revision increased with increasing total temperature drop. Analysis of various possible thresholds showed that the optimal temperature cutoff may be lower than suggested by the manufacturer (0.125°C vs 0.2°C).ConclusionThis is the first study to report a strong association between thermal flow evaluation and a clinical impression that a shunt is not malfunctioning. The current recommended threshold may increase the false positive rate unnecessarily, and as clinicians gain experience with the method, they may find value in examining the temperature curves themselves. Multicenter studies are suggested to further define a role for this diagnostic test.Copyright © 2018 by the Congress of Neurological Surgeons.

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