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Jotham C. Manwaring, Devon Truong, Armen R. Deukmedjian, Carolyn M. Carey, Bruce B. Storrs, Luis F. Rodriguez, Lisa Tetreault and Gerald F. Tuite

S evere cranial deformity can occur after shunt placement in newborns with extreme hydrocephalus. Deformity frequently develops due to CSF overdrainage. This problem can be lessened with the use of programmable shunts, high-pressure valves, or flow-control devices, with or without the use of a cranial orthotic helmet and vigilant repositioning. 1 However, despite these efforts, hydrocephalic newborns with macrocephaly who undergo CSF shunting, and who have a high proportion of intracranial CSF compared with brain parenchyma, are still at risk for marked

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Cormac O. Maher, Hugh J. L. Garton, Wajd N. Al-Holou, Jonathan D. Trobe, Karin M. Muraszko and Eric M. Jackson

-Murcia M , López-Guerrero AL : CSF overdrainage in shunted intracranial arachnoid cysts: a series and review . Childs Nerv Syst 25 : 1061 – 1069 , 2009 50 McDonald PJ , Rutka JT : Middle cranial fossa arachnoid cysts that come and go. Report of two cases and review of the literature . Pediatr Neurosurg 26 : 48 – 52 , 1997 51 Mokri B , Houser OW , Dinapoli RP : Spontaneous resolution of arachnoid cysts . J Neuroimaging 4 : 165 – 168 , 1994 52 Mori K , Yamamoto T , Horinaka N , Maeda M : Arachnoid cyst is a risk factor for

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Jung Won Choi, Seung-Ki Kim, Kyu-Chang Wang, Ji Yeoun Lee, Jung-Eun Cheon and Ji Hoon Phi

, intraventricular hemorrhage (IVH), and catheter malposition. 11 , 17 In the later postoperative period, shunt malfunction, infection, catheter migration, bowel perforation, catheter exposure, and CSF overdrainage can ensue. 18 Obviously, VP shunt surgery is a simple surgical procedure; however, the complications associated with the procedure can cause problems for neurosurgeons and their patients. In certain situations, uncommon complications can occur after shunting procedures. We encountered several patients with noteworthy complications over the last 10 years

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Lissa C. Baird, Catherine A. Mazzola, Kurtis I. Auguste, Paul Klimo Jr. and Ann Marie Flannery

AA , Galarza M , Masterman-Smith M , Lemus R , Lazareff JA : Distal slit valve and clinically relevant CSF overdrainage in children with hydrocephalus . Childs Nerv Syst 18 : 15 – 18 , 2002 44 Warf BC : Comparison of 1-year outcomes for the Chhabra and Codman-Hakim Micro Precision shunt systems in Uganda: a prospective study in 195 children . J Neurosurg 102 : 4 Suppl 358 – 362 , 2005

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Terje Sæhle and Per Kristian Eide

S hunt surgery is the primary treatment of pediatric and adult hydrocephalus, 42 although shunt failure requiring shunt revision is frequent. 2 , 8 , 12 , 45 Shunt failure may be accompanied by over- or underdrainage of CSF. When the shunt is draining too much CSF (overdrainage), symptoms such as headache and dizziness may arise. 9 , 37 However, symptoms such as headache and dizziness may also be caused by CSF underdrainage, e.g., due to obstruction of the CSF catheter. 10 The shunt valves with adjustable CSF opening pressure have been reported to

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Kaveh Barami

of the craniospinal axis. Assessment via brain and spinal MRI with contrast to demonstrate cerebral venous overdrainage and Doppler ultrasonography to assess flow through the cranial venous outflow tracts are also helpful noninvasive adjuncts in the management of adult hydrocephalus and may guide therapy. Antisiphon devices may mitigate the long-term effect of chronic CSF overdrainage from a shunt causing cerebral venous overdrainage. Further research must be done to better define patients at risk and to identify modulating factors of the cerebral venous

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Hans-Georg Schlosser, Hans-Joachim Crawack, Christoph Miethke, Thoralf Knitter, Andreas Zeiner and Christian Sprung

SD , Canady AI , Greninger N : Useful components of the shunt tap test for evaluation of shunt malfunction . Childs Nerv Syst 9 : 157 – 162 , 1993 34 Tschan CA , Antes S , Huthmann A , Vulcu S , Oertel J , Wagner W : Overcoming CSF overdrainage with the adjustable gravitational valve proSA . Acta Neurochir (Wien) 156 : 767 – 776 , 2014 35 Vassilyadi M , Tataryn ZL , Matzinger MA , Briggs V , Ventureyra EC : Radioisotope shuntograms at the Children's Hospital of Eastern Ontario . Childs Nerv Syst 22 : 43 – 49

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Jason Man-kit Ho, Hing-Yuen Law, Shing-Chau Yuen and Kwong-Yui Yam

overshunting is encountered. Conclusions Although rare, chronic CSF overdrainage can lead to cervical myelopathy due to spinal cord compression by the dilated vertebral veins/epidural venous plexus. Awareness of this reversible condition can prevent unnecessary delay in treatment and thereby improve outcomes significantly. Acknowledgments We wish to acknowledge the assistance of the Department of Radiology and Nuclear Medicine, Tuen Mun Hospital, Hong Kong. References 1 Chung SJ , Kim JS , Lee MC : Syndrome of cerebral spinal fluid hypovolemia

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Devi Prasad Patra, Shyamal C. Bir, Tanmoy K. Maiti, Piyush Kalakoti, Hugo Cuellar, Bharat Guthikonda, Hai Sun, Christina Notarianni and Anil Nanda

important than volume reduction to achieve a successful shunt outcome. The most striking and new finding in the current study was related to the shunt revision interval and shunt revision frequency. The reduction in the FOHR was interestingly high in patients who required early shunt revision. This paradoxical finding is probably related to the fact that CSF overdrainage leads to CSF stasis and a greater chance of mechanical shunt obstruction. 3 Most of the shunts that are routinely used are pressure regulated. A compliant ventricular wall causes rapid decompression of