Related Experiment Video
Updated: Apr 26, 2026
14:59
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
12.2K
Over-shunting associated myelopathy.
Brian M Howard1, Eric A Sribnick1, Sanjay S Dhall2
1Department of Neurological Surgery, Emory University School of Medicine, 1365-B Clifton Road, NE, Ste. 2200, Atlanta, GA 30322, USA.
Summary
Over-shunting following cerebrospinal fluid (CSF) diversion can cause rare but serious cervical myelopathy. This condition involves engorged cervical epidural venous plexus, leading to spinal cord compression.
Area of Science:
- Neurosurgery
- Neurology
Background:
- Intracranial hypotension often follows cerebrospinal fluid (CSF) leaks but can also result from CSF diversion procedures.
- Common symptoms include positional headaches, though neck pain and cranial nerve palsies are less frequent presentations.
Observation:
- The case involves a 26-year-old woman with congenital hydrocephalus requiring a ventriculoperitoneal shunt.
- She developed rapidly progressive cervical myelopathy after a shunt revision procedure.
Findings:
- Imaging demonstrated engorgement of the cervical epidural venous plexus, causing mass effect on the cervical spinal cord.
- This presentation is termed "over-shunting associated myelopathy," a rare complication of CSF diversion.
Implications:
- Physicians managing patients with intracranial shunts must be aware of over-shunting associated myelopathy.
- Early recognition and management are crucial for patients experiencing neurological decline after CSF diversion.
Related Concept Videos
01:25Secondary Spinal Cord Injury llI: Pathophysiology
40
Early Ischemia and Ionic ImbalanceWithin minutes of spinal cord injury, a secondary cascade begins, progressing over hours to weeks. Vascular damage reduces blood flow, causing ischemia and mitochondrial dysfunction. ATP depletion leads to ion pump failure, membrane depolarization, sodium influx, potassium efflux, and water accumulation, resulting in cellular swelling. Increased intracellular calcium further disrupts mitochondria and accelerates cellular injury.Excitotoxicity and Neuronal...
40
01:19Multiple Sclerosis l: Introduction
16
Multiple sclerosis is a chronic autoimmune disease of the central nervous system (CNS) that affects the brain, spinal cord, and optic nerves. It is an inflammatory demyelinating disorder and a leading cause of neurological disability in young adults.EpidemiologyMS commonly begins between 20 and 40 years of age and is twice as common in women. Its exact cause remains unclear, but genetic susceptibility contributes, with higher risk in first-degree relatives and identical twins. A greater...
16
01:14Spinal Cord Injury ll: Pathophysiology
18
Spinal cord injury progresses through two interconnected phases: primary injury and secondary injury.Primary InjuryPrimary injury happens at the moment of trauma and involves immediate mechanical damage to the spinal cord.Compression happens when broken vertebrae, herniated discs, or accumulating blood (such as a hematoma) press directly against the spinal cord, distorting its normal shape and function. In cases of contusion, the cord is bruised by a blunt force (like penetrating injuries or...
18