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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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Ian F. Pollack, Dachling Pang and A. Leland Albright

because of recurrent ventricular dilatation. None of the children underwent biopsy or radiotherapy initially. Subsequently, each child was closely followed with serial imaging studies and clinical examinations. Results Four children, three of whom were noted to have significant macrocephaly at presentation, had multiple problems related to CSF overdrainage following shunt insertion. One such patient suffered chronic low-pressure headaches and required several shunt revisions. Three other children (one of whom had a flow-regulated valve placed initially

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Wouter I. Schievink, Ronald Reimer and W. Neath Folger

P ostural headache secondary to low intracranial pressure is a well-known entity in neurosurgical practice. It is most commonly encountered following lumbar puncture for cerebrospinal fluid (CSF) examination or myelography. Postural headache may also be experienced following craniotomy, spinal surgery, or craniospinal trauma when the dura has been violated, in association with oto- or rhinorrhea, or as a result of CSF overdrainage in patients with ventriculoperitoneal shunts. Uncommonly, it occurs as a consequence of medical conditions such as severe

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Sotaro Higashi, Kazuya Futami, Hiroshi Matsuda, Junkoh Yamashita, Masaaki Hashimoto, Mitsuhiro Hasegawa, Kazuhiko Tokuda, Mahmood Hassan and Kinichi Hisada

Syndrome Low-ICP syndrome is characterized by headache, nausea, vomiting, lethargy, and even diplopia and paresis of upward gaze. 9, 28 It is usually associated with the upright position, and it is frequently relieved by lying down. Postural symptoms of low-ICP syndrome have been believed to be due to negative ICP secondary to CSF overdrainage. Although the majority of patients with a DP valve shunt have significantly negative VFP in the upright position, they do not always develop low-ICP syndrome; 1, 2, 3 the explanation for this is not known. In the present study

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Madan Samuel, David M. Burge and Robert J. Marchbanks

CSF shunt was changed to one with a different flow and pressure character in an attempt to minimize the excessive reduction of intraventricular pressure and volume due to CSF overdrainage ( Fig. 2 lower ). The symptoms of low ICP gradually disappeared with the return of the TMD test measurement to normal baseline values. At present these patients' headaches are intermittent, less severe in intensity, and not incapacitating. Discussion Clinical Features In patients who have shunt-dependent hydrocephalus, the overt neurological symptoms of relative

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Hiroji Miyake, Tomio Ohta, Yoshinaga Kajimoto and Kohji Nagao

C erebrospinal fluid shunt placement to treat patients with hydrocephalus is one of the most popular procedures in the neurosurgical field. Various improvements have been made to shunt systems since Torkildsen 16 first described closed CSF drainage. Recent innovations in programmable pressure valves have led to epoch-making advances in the treatment of hydrocephalus, increasing the precision of postoperative control of shunt systems. It has been reported that complications such as CSF overdrainage have decreased as a result. 1, 5, 12, 17 In reality, however

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Koreaki Mori

this risk, it is suggested that an antisiphon device be incorporated in the shunting system to prevent CSF overdrainage. 10 If such an antisiphon device is used, it should be placed in an appropriate position—at least 10 cm below the burr hole—so as not to cause underdrainage of CSF. 32 Future Study Future efforts should be directed toward better identification of the pathogenesis of idiopathic NPH, the development of better diagnostic criteria for identifying patients with idiopathic NPH, and long-term follow-up review for those NPH patients treated with

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Chris Xenos, Spiros Sgouros, Kalyan Natarajan, A. Richard Walsh and Anthony Hockley

while the patient is in the upright position, which is due to the siphon effect, is the most difficult complication to counteract. The small ventricles found in patients with CSF overdrainage have been shown to lead to an increased incidence of proximal shunt obstruction. 2, 4, 16 New shunt valve designs incorporating antisiphon and flow-control devices, based on a more sophisticated physiological control of CSF drainage, have been introduced since the late 1980s in an attempt to correct the generally recognized poor result obtained with CSF shunts. 5 Unfortunately

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Dennis A. Nowak, Sven-Olaf Rodiek, Jürgen Zinner, Albrecht Guhlmann and Helge Topka

, according to Mokri, 5 is consistent with some clinicoimaging aspects of our case. The acephalic presentation has been related to CSF overdrainage and is noticed primarily in elderly patients after CSF shunt-placement procedures for communicating hydrocephalus. Typically, sinking of the brain is absent on MR images, as in our case. In elderly patients with hydrocephalus, it has been assumed that the decreased weight of the brain due to atrophy and enlarged fluid-filled ventricles reduces the orthostatic descent of the brain. In the present case, however, MR images of the

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Patrick W. Hanlo, Giuseppe Cinalli, W. Peter Vandertop, Joop A. J. Faber, Lars Bøgeskov, Svend E. Børgesen, Jürgen Boschert, Paul Chumas, Hans Eder, Ian K. Pople, Willy Serlo and Eckehard Vitzthum

OSV II shunt survival in 62% of patients (95% CI 60–64%) at the 5-year follow-up examination. The present findings demonstrate that the OSV II shunt system considerably reduces the rate of complications related to overdrainage and to shunt obstruction, particularly any obstruction due to occlusion of the catheter (distal or proximal). The finding that slitlike ventricles caused by CSF overdrainage are strongly related to poor long-term outcome due to ventricular catheter blockage has opened a potential area for improvement in shunt survival. 16, 26, 32, 40, 42, 43