Introduction
The ever present need to balance over drainage with under drainage in hydrocephalus has required innovations including adjustable valves with antigravity devices. These are activated in the vertical position to prevent siphoning. We describe a group of patients who presented with unexplained under drainage caused by activation of antigravity shunt components produced by peculiar head/body position.
Methods
Single centre case series of hydrocephalus patients, treated with ventriculo-peritoneal shunt insertion. These patients presented with clinical and radiological under drainge syndrome. Medical notes were reviewed for clinical picture and outcome. Radiological studies were reviewed assessing shunt placement and ventricular size.
Results
Four patients presented with clinical and radiological under drainage syndrome. A consistent posturing of long term hyper-flexion of the neck whilst lying supine was observed. All patients had similar shunt construct (adjustable Miethke proGAV valve and shunt assistant antigravity component). In each of those patients a hypothesis was formulated that neck flexion was activating the shunt assistance antigravity component in supine position. All patients underwent shunt revision surgery removing the shunt assistant device from the cranium and adding an antigravity component to the shunt system at the chest. All patients had clinical and radiological improvement.
Conclusions
The combination of raised ICP when supine and a resistant shunt assistant could be blamed for worsening hydrocephalus. In bedridden hydrocephalus patients with a shunt assistant, consider the possibility of shunt deception due to abnormal neck positioning. In these patients, antigravity devices should be placed at the chest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
This article is published under an open access license. Please check the 'Copyright Information' section either on this page or in the PDF for details of this license and what re-use is permitted. If your intended use exceeds what is permitted by the license or if you are unable to locate the licence and re-use information, please contact the Rights and Permissions team.
About this article
Cite this article
Craven, C., Patel, N.A., Asif, H. et al. Shunt assistant device deception due to pseudovertical posturing. Fluids Barriers CNS 12 (Suppl 1), P10 (2015). https://doi.org/10.1186/2045-8118-12-S1-P10
Published:
DOI: https://doi.org/10.1186/2045-8118-12-S1-P10