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Hart Schutz, Karel G. Ter Brugge, Ming C. Chiu, Angele Mongul and Ferelith Taylor

C linical status and computerized tomography (CT) scanning are the most convenient methods of assessing patency of a cerebrospinal fluid (CSF) shunt. When either of these methods is not conclusive, then other means of ascertaining shunt function may be necessary. Such methods include: injection of contrast medium or radioactive substances into the flushing device; 1, 2 digital compression of the flushing device to determine response; assessment of flow by Doppler ultrasound methods; 3 temperature change determinations in a flowing CSF column; 4 and a lumbar

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, Green RC: Effect of CSF shunts on intracranial pressure and CSF dynamics. J Neurol Neurosurg Psychiat, in press). References 1. Hakim S , Burton JD : A comparison between natural and artificial vales for the drainage of spinal fluid. Paper delivered at the European Congress of Pediatric Neurosurgery , Gottingen , September 3–7, 1972 Hakim S, Burton JD: A comparison between natural and artificial vales for the drainage of spinal fluid. Paper delivered at the European Congress of Pediatric Neurosurgery, Gottingen, September

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Myles E. Gombert, Sheldon H. Landesman, Michael L. Corrado, Sherman C. Stein, Ellen T. Melvin and Marinella Cummings

T he most common cause of meningitis associated with cerebrospinal fluid (CSF) shunt devices is Staphylococcus epidermidis . 15 Depending upon the institution, 10% to 41% of isolates are resistant to semisynthetic penicillins, such as methicillin. 12, 16 The cephalosporins have been recommended as alternatives to the semisynthetic penicillins in the treatment of infections due to methicillin-resistant S. epidermidis , yet poor penetrability into the CSF, and the emergence of resistant strains, caution against the use of these antibiotics. 9 Vancomycin has

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Peter T. Frame and Robert L. McLaurin

mortality rates associated with CSF shunt infections ranged from 35% to 40%; more recent series have suggested a more stable infection rate of 10% to 15% and a reduced mortality rate from CSF shunt infection to 5% to 10% of those infected. 7, 16, 24, 25 Management strategies for CSF shunt infection can be divided roughly into two approaches, 10 the first holds that all foreign bodies must be removed from an infection site and the infection cleared with antibiotics before new shunt materials can be placed. These patients thus require two operations and some temporary

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Sherman C. Stein and Stewart Apfel

R eports on the success of using thermal transfer to assess cerebrospinal fluid (CSF) shunt patency 1, 2, 6, 7 have confirmed the validity of this approach in ascertaining flow through shunts. With the thermal technique, a thermistor is placed on the skin over subcutaneous shunt tubing and the skin over the proximal tubing is cooled. Movement of chilled CSF in the tubing, either during spontaneous flow or using the shunt flushing device, causes a temperature drop which is registered by the thermistor to confirm shunt patency. Attempts to relate the rate of

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Abhaya V. Kulkarni, Jay Riva-Cambrin, Jerry Butler, Samuel R. Browd, James M. Drake, Richard Holubkov, John R. W. Kestle, David D. Limbrick, Tamara D. Simon, Mandeep S. Tamber, John C. Wellons III, William E. Whitehead and for the Hydrocephalus Clinical Research Network

A lthough CSF shunting has been the most widely used treatment for hydrocephalus over the past half century, it is unclear whether outcomes of shunting have improved dramatically over time. Since 2006, the HCRN, a multicenter network of pediatric neurosurgical institutions, has been dedicated to collecting high-quality data on the outcomes of hydrocephalus treatment in children. 6 , 11 , 13 The HCRN currently comprises 7 centers in North America and provides a unique opportunity for assessing the current outcomes of CSF shunting in nonselected patients

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Neurosurgical Forum: Letters to the Editor To The Editor Jan Goffin , M.D. Christiaan Plets , M.D. University Clinic Gasthuisberg Leuven, Belgium 989 989 We have read with great interest the article by Ruge, et al. , concerning 11 cases of pneumocephalus occurring in patients with permanent cerebrospinal fluid (CSF) shunts (Ruge J, Cerullo LJ, McLone DG: Pneumocephalus in patients with CSF shunts. J Neurosurg 63: 532–536, October 1985). We wish to add another case, which we had the

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Kouhei Echizenya, Masaharu Satoh, Hiroshi Murai, Hiroo Ueno, Hiroshi Abe and Takashi Komai

E arly in the 1950's, silicones were introduced as materials suitable for implantation. 22 At about that time, silicones were used for the manufacture of cerebrospinal fluid (CSF) shunting systems in neurosurgery. These elastomers were known from the outset to have many desirable attributes such as high flexibility, chemical stability, and nontoxicity. 3, 15 However, research is now available to indicate that the high lipophilic property may cause a gradual deterioration in dynamic performance. 23, 26 Silicone implants, such as finger joint prostheses in

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John R. Ruge, Leonard J. Cerullo and David G. McLone

P neumocephalus was first described in 1884 by Chiari 2 as an autopsy finding in a patient who died of ethmoiditis. Luckett 17 was the first to make the roentgenographic diagnosis of pneumocephalus in 1913. Since then, more than 370 such cases have been described. Between 1914 and 1918, there were frequent reports of pneumocephalus secondary to war injuries. Indeed, the majority of cases of pneumocephalus are caused by trauma. 18 In 1962, pneumocephalus was reported by Kessler and Stern 12 as a complication of cerebrospinal fluid (CSF) shunting in a

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Hiroshi Yamada

✓ A method of regulating flow rate through cerebrospinal fluid (CSF) shunts with the addition of a flow-regulating device (FRD) is reported. The FRD consists of a small-caliber (0.4 mm) Teflon tube placed in the usual connector. This device has the advantage of converting the original shunt valves to valves for higher-resistance flow without replacing the entire distal catheter. An experimental study revealed that this device reduced the CSF flow rate in the shunt system by approximately 30%. The author has found it reliable in 32 patients, without causing CSF obstruction. The device is easily installed and removed.