The hydrokinetic parameters of shunts for hydrocephalus might be inadequate

Abstract

Long-term treatment of hydrocephalus continues to be dismal. Shunting is the neurosurgical procedure more frequently associated with complications, which are mostly related with dysfunctions of the shunting device, rather than to mishaps of the rather simple surgical procedure. Overdrainage and underdrainage are the most common dysfunctions; of them, overdrainage is a conspicuous companion of most devices. Even when literally hundreds of different models have been proposed, developed, and tested, overdrainage has plagued all shunts for the last 60 years. Several investigations have demonstrated that changes in the posture of the subject induce unavoidable and drastic differences of intraventricular hydrokinetic pressure and cerebrospinal fluid (CSF) drainage through the shunt. Of all the parameters that participate in the pathophysiology of hydrocephalus, the only invariable one is cerebrospinal fluid production at a constant rate of approximately 0.35 ml/min. However, this feature has not been considered in the design of currently available shunts. Our experimental and clinical studies have shown that a simple shunt, whose drainage capacity complies with this unique parameter, would prevent most complications of shunting for hydrocephalus.

Case Report: Stimulation of the Right Amygdala Induces Transient Changes in Affective Bias

“…The amygdala is widely implicated in mood regulation (12), but it has remained poorly characterized by stimulation studies (13–15). Based on limited previous studies (16), our second hypothesis was that such stimulation would be effective in altering mood and AB.…”

Laparoscopic revision of the distally obstructed ventriculoperitoneal shunt

“…Mechanical failure after shunt insertion was found in 10%-70% of cases in different studies (1,12,19,23,29) and in our study mechanical failure was found in 46.9% of the shunt procedures. This finding is parallel to some series and not other series.…”

“…Cerebrospinal fluid (CSF) diversion procedures are a common daily task for neurosurgeons and it is still the most common modality of treatment for hydrocephalus in spite of reported and known complications of ventriculo-peritoneal shunt (VPS) (2,7,14,17,24,25,29,30,31,32).…”

“…Ventriculoperitoneal shunt (VPS) is a common neurosurgical procedure and considered the most commonly accepted treatment for hydrocephalus (2,7,14,17,29,30,31,32), however it can be considered one of the most common neurosurgical procedures associated with complications (3,10). Those complications include mechanical failure, infection, and disconnection or fractured segment with or without migration of the shunt tube (3,10,14,29,32).…”

“…Those complications include mechanical failure, infection, and disconnection or fractured segment with or without migration of the shunt tube (3,10,14,29,32).…”