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Rolf Gruber, Peter Jenny and Bruno Herzog

O bstruction of the ventricular catheter with fibrin, neuroglia, or plexus tissue is still the most frequent complication of cerebrospinal fluid (CSF) shunts in pediatric hydrocephalus 4, 8, 11, 12 The failure of customarily used shunt systems to inhibit chronic CSF overdrainage when the patient is mobilized is, in our experience, the major cause of this complication. 6 We believed that the patient's well-being might improve and the complication rate might be diminished by safeguarding the shunt system with a suction-inhibiting anti-siphon device (ASD

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Letters to the Editor To The Editor John L. Fox , M.D. Riyadh, Saudi Arabia 1157 1159 Having read the interesting article by Dr. Gruber and his colleagues (Gruber R, Jenny P, Herzog B: Experiences with the anti-siphon device (ASD) in shunt therapy of pediatric hydrocephalus. J Neurosurg 61: 156–162, July, 1984), I thought your readers might be interested in some of the brief history behind the anti-siphon valve, which was developed by Portnoy and Schulte. 5 After our earlier investigations into pressures

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Donald Horton and Michael Pollay

T he flow characteristics of the first commercially available anti-siphon valve, designed as an anti-siphon device (ASD) for ventricular shunting, were reported by Portnoy, et al. , 15 in 1973. In the present paper, we discuss a similar device that has some advantages over the earlier ASD when used in conjunction with presently available differential-pressure valves for the treatment of hydrocephalus. The necessity for control of cerebrospinal fluid (CSF) outflow from the ventricular system while the patient is in an upright position has been appreciated for

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distinguished the differences between the antisiphon device (ASD) and the Delta valve; furthermore, they erroneously suggest that the Delta valve is equivalent to the ASD referred to in the article by da Silva and Drake. 1 In the erect position, the ASD tends to increase resistance to flow to a level that stops the flow of cerebrospinal fluid (CSF). This is due to the ASD design, which has an inlet-to-outlet surface area ratio of only 8:1. Specifically, the 20:1 ratio of the Delta valve eliminates the siphoning effect while only increasing the resistance to flow in the erect

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Neurosurgical Forum: Letters to the Editor To The Editor John W. Holter , D.Sc. Bridgeport, Pennsylvania 791 791 The fine article by Gruber, et al. (Gruber R, Jenny P, Herzog B: Experiences with the anti-siphon device (ASD) in shunt therapy of pediatric hydrocephalus. J Neurosurg 61: 156–162, July, 1984) and the comments by Drs. Fox and Portnoy 1, 2 are well done. However, we believe there are a few points that should be clarified. First, in the scientific community we usually strive for accuracy in work

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Bo Lundkvist, Anders Eklund, Bo Kristensen, Markku Fagerlund, Lars-Owe D. Koskinen and Jan Malm

systems in an in vivo setting. 8, 14, 21 Recently, we introduced a CSF infusion method to be used pre- and postoperatively in patients with communicating hydrocephalus. This in vivo technique makes it possible to assess CSF hydrodynamics postoperatively and to determine the properties of the shunt system, including the degree of gravity-induced CSF flow. 21 The traditional differential pressure valves are sensitive to body posture, which may induce overdrainage due to siphoning. Valves with ASDs may decrease these complications, but inadequate drainage of CSF due to

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Mahmood Hassan, Sotaro Higashi and Junkoh Yamashita

cranial sutures. 15 Furthermore, our recent study of cerebral blood flow in patients whose shunts had differential-pressure valves revealed abnormal intracranial hemodynamics. 9 To relieve these complications, siphon-reducing devices have been developed. Portnoy, et al. , 19 developed the antisiphon device (ASD) in 1973. A new siphon-reducing device, the siphon-control device (SCD), was reported by Horton and Pollay 11 with some improvements over ASD in construction. The Delta valve, in which SCD is incorporated with differential-pressure valve, was developed in

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Chang Sub Lee, Seok Ho Hong, Kyu-Chang Wang, Seung-Ki Kim, Joong Shin Park, Jong-Kwan Jun, Bo Hyun Yoon, Young-Ho Lee, Son Moon Shin, Yeon Kyung Lee and Byung-Kyu Cho

, PDA, ASD 20 AS, AC, ASD, cricopharyngeal incoordination 22 venous angioma 23 ACC, AC Aicardi syndrome 24 MMC, CM-II ACC, syringomyelia 27 ACC, PDA 28 ACC, AC 29 pineal cyst 31 PVL 35 ACC, CM-I 40 cortical dysplasia, PVL, congenital clubfoot 41 ACC 42 band heterotopia, PVL 44 AS * Cases with germinal matrix hemorrhage and cysts were excluded. Abbreviations: AC = arachnoid cyst; ACC = agenesis of corpus callosum; AS = aqueductal stenosis; ASD = atrial septal

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Sepehr Sani, Kirk W. Jobe and Richard W. Byrne

to the skull. N Engl J Med 345: 339, 2001 9. Spiers ASD : Attempted suicide or hitting the nail on the head. Case report. J Fla Med Assoc 81 : 822 – 823 , 1994 Spiers ASD: Attempted suicide or hitting the nail on the head. Case report. J Fla Med Assoc 81: 822–823, 1994 10. Tancioni F , Gaetani P , Pugliese R , Rodriguez Y , Baena R : Intracranial nail. A case report. J Neurosurg Sci 38 : 239 – 243 , 1994 Tancioni F, Gaetani P, Pugliese R, Rodriguez Y, Baena R

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Surgical treatment of cerebral metastases from lung cancer

The effect on quality and duration of survival

Edwin E. MacGee

: Metastatic tumors of the brain: a follow-up study of 195 patients with neurosurgical considerations. J Neurosurg 17 : 361 – 373 , 1960 Simionescu MD: Metastatic tumors of the brain: a follow-up study of 195 patients with neurosurgical considerations. J Neurosurg 17: 361–373, 1960 18. Spiers ASD : Cerebral metastases from carcinoma of the lung. Med J Aust 2 : 178 – 183 , 1969 Spiers ASD: Cerebral metastases from carcinoma of the lung. Med J Aust 2: 178–183, 1969 19. Stoier M : Metastatic tumors of