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Periventricular rigidity in long-term shunt-treated hydrocephalus
Sandeep Sood1, Jaliya Lokuketagoda, Steven D Ham
1Department of Pediatric Neurosurgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan 48201, USA. ssood@med.wayne.edu
Journal of Neurosurgery
|September 15, 2005
Summary
Periventricular rigidity does not prevent ventricles from enlarging after shunt malfunction in pediatric patients. This finding challenges the common assumption about shunt-dependent hydrocephalus management.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Biomedical Engineering
Background:
- Shunt-dependent hydrocephalus requires cerebrospinal fluid diversion.
- Acute shunt malfunction can lead to slit ventricles.
- Periventricular rigidity from gliosis is thought to impede ventricular enlargement.
Purpose of the Study:
- To investigate the presence of periventricular rigidity in pediatric patients with acute shunt malfunction.
- To test the hypothesis that periventricular rigidity limits ventricular expansion.
Main Methods:
- Studied 15 pediatric patients with acute shunt malfunction and slit ventricles.
- Measured intraventricular pressure (IVP) and intraparenchymal pressure (IPP) simultaneously.
- Recorded pressure changes after bolus fluid infusion into the ventricle before and after shunt revision.
Main Results:
- Mean IVP at presentation was 24.1 mm Hg.
- Mean baseline IVP after CSF drainage was 7.5 mm Hg.
- No significant difference in IVP and IPP increase after fluid infusion (p = 0.39).
Conclusions:
- The study's pressure data suggests periventricular walls do not restrict ventricular enlargement.
- Findings challenge the established understanding of shunt malfunction consequences.
- Re-evaluation of periventricular rigidity's role in shunt-dependent hydrocephalus is warranted.