Spectral analysis of intracranial pressure: Is it helpful in the assessment of shunt functioning in-vivo?

Objective Shunt failure is common in hydrocephalic patients. The cerebrospinal fluid (CSF) infusion test enables the assessment of CSF absorption capacity, which is represented by the resistance to CSF outflow (R_OUT) However, shunt failure may not only affect the CSF absorption capacity but also the intracranial compliance or compensatory properties. Spectral analysis of the ICP signal obtained during the infusion test may enable the comprehensive assessment of the overall deterioration caused by shunt failure. Material and methods A total of 121 hydrocephalic shunted patients underwent the infusion test with continuous intracranial pressure (ICP) and arterial blood pressure (ABP) recording. The maximum amplitudes of three major frequency bandwidths (0.2-2.6, 2.6-4.0 and 4.0-15 Hz, respectively) were calculated from the ICP. Statistical analyses were conducted to identify factors significantly associated with shunt failure, to construct an index (i.e., the shunt response parameter, SRP) for detecting shunt failure, and to define thresholds for R_OUT and SRP. Results The R_OUT threshold for detecting shunt failure was 7.59 mmHg/ml/min, and this threshold showed an accuracy of 82.64%. All spectral parameters were found to be significantly associated with shunt patency (p <0.05). The SRP exhibited significantly better accuracy than R_OUT in detecting shunt failure (91.74%). Conclusion The hydrodynamic assessment of shunted patients enhanced by spectral analysis during the infusion test detected shunt failure with high accuracy. Although further validation is needed, the SRP exhibited promising results.