How to define CSF overdrainage: a systematic literature review

Area of Science:

• Neurosurgery
• Neurology
• Medical Complications

Background:

• Overdrainage (OD) is a frequent complication of cerebrospinal fluid (CSF) shunting procedures.
• Varied incidence reporting stems from a lack of consensus on diagnostic criteria and pathophysiology.
• OD is likely underreported and underestimated in clinical practice.

Approach:

• A systematic literature search was conducted in MEDLINE and EMBASE to identify studies defining or describing diagnostic findings of OD in hydrocephalus treated with ventriculoperitoneal shunts.
• Studies were graded based on the precision of OD terminology, with Class I studies included for further analysis.
• A clinical expert panel assessed the quality of extracted descriptions.

Key Points:

• A total of 1309 studies were screened, resulting in 22 Class I studies providing specific definitions or descriptions of OD.
• Thirty-two distinct characteristics associated with OD were extracted, encompassing clinical symptoms, radiological signs, and specific syndromes.
• Key clinical manifestations include postural headache, nausea, and vomiting.

Conclusions:

• CSF overdrainage is characterized by persistent postural headache, nausea, vomiting, slim ventricles, and/or subdural collections.
• A consensus definition is crucial for accurate diagnosis and management of OD.
• This review provides a foundation for understanding and reporting OD.