SignificanceShuntodynia is patient reported pain at the site of the implanted ventriculoperitoneal (VP) shunt. Pediatric hydrocephalus requiring shunt placement is a chronic and prevalent standard of care treatment and requires lifetime management. Shuntodynia is a subjective measure of shunt dysfunction. Quantitative, white-light tissue spectroscopy could be used to objectively identify this condition in the clinic.AimPediatric subjects were recruited for optical sensing during routine clinical follow-up visits, post-VP shunt implantations. Acquired optical signals were translated into skin-hemodynamic signatures and were compared between subjects that reported shuntodynia versus those that did not.ApproachDiffuse reflectance spectroscopy (DRS) measurements were collected between 450 and 700 nm using a single-channel fiber-optical probe from (N=35) patients. Multiple reflectance spectra were obtained by the attending physician from regions both proximal and distal to the VP shunt sites and from a matched contralateral site for each subject. Acquired reflectance spectra were processed quantitatively into functional tissue optical endpoints. A two-way, repeated measures analysis of variance was used to assess whether and which of the optical variables were statistically separable, across subjects with shuntodynia versus those without.ResultsAnalyses indicated that intrapatient differences in vascular oxygen saturation measured between shunt sites relative to that obtained at the scar or contralateral sites was significantly lower in the pain group. We also find that the total hemoglobin concentrations at the shunt site were lowest relative to the other sites for subjects reporting pain. These findings suggest that shuntodynia pain arises in the scalp tissue around the implanted shunts and may be caused due to hypoxia and inflammation.ConclusionsOptically derived hemodynamic variables were statistically significantly different in subjects presenting with shuntodynia relative to those without. DRS could provide a viable mode in routine bedside monitoring of subjects with VP shunts for clinical management and assessment of shuntodynia.
Diffuse reflectance spectroscopy (DRS) is a well-established technology for quantitative, non-invasive, and rapid measurement of tissue hemodynamics. We used DRS scans collected between 450-700 nm using a single-channel fiber optical probe in hydrocephalus pediatric patients with implanted shunts to investigate whether idiopathic pain experienced at the shunt site was identifiable in hemodynamic signatures from measurements. The relationship between the presence of shunt-related pain by were examined using localized DRS measurements using an optical probe with short source-detector separation. DRS scans were collected at seven different sites around the implanted shunt and from a matched contralateral site, from subjects during routine clinical visits. Reflectance data were processed using an inverse Monte Carlo model to translate each DRS spectrum into the wavelength averaged scattering coefficient, the total hemoglobin concentration, and vascular blood oxygen saturation. DRS variables from acquired measurements were examined across patient groups using statistical t-tests. Preliminary results indicate a reduced hemoglobin saturation for subjects presenting with shuntodynia and need to be examined in greater detail to identify whether these optical signals indicate early-development of pressure injuries in tissues.
Access to the requested content is limited to institutions that have purchased or subscribe to SPIE eBooks.
You are receiving this notice because your organization may not have SPIE eBooks access.*
*Shibboleth/Open Athens users─please
sign in
to access your institution's subscriptions.
To obtain this item, you may purchase the complete book in print or electronic format on
SPIE.org.
INSTITUTIONAL Select your institution to access the SPIE Digital Library.
PERSONAL Sign in with your SPIE account to access your personal subscriptions or to use specific features such as save to my library, sign up for alerts, save searches, etc.