American Academy of Pediatrics – Section on Neurological Surgery

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March 15, 2021

Do not perform routine imaging for evaluation of VP shunt function in a patient without signs or symptoms of shunt malfunction.

Routine imaging to evaluate ventricle size in an asymptomatic patient with hydrocephalus is not necessary. When imaging is needed, performing a rapid brain MRI is a recommended option to prevent radiation exposure to the child. Surveillance imaging, if needed, should only be ordered by specialists who treat hydrocephalus.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The pediatric neurosurgery Choosing Wisely topics were chosen after discussion among the Section on Neurological Surgery (SONS) Executive Committee members regarding the most common pediatric neurosurgery issues and treatments general pediatricians see in their practices. Various expert committees and sections of the AAP reviewed and approved the list. The AAP Executive Committee then granted final approval of the list.

AAP’s disclosure and conflict of interest policy can be found at


Flannery AM et al. Pediatric Hydrocephalus Guideline. Schaumburg, IL: Congress of Neurological Surgeons; 2014. Available at: guideline

Koral K, Blackburn T, Bailey AA, Koral KM, Anderson J. Strengthening the argument for rapid brain MR imaging: estimation of reduction in lifetime attributable risk of developing fatal cancer in children with shunted hydrocephalus by instituting a rapid brain MR imaging protocol in lieu of head CT. AJNR Am J Neuroradiol. 2012;33(10):1851-1854