title: Pressure compensation in shunt-dependent hydrocephalus with CSF shunt malfunction.
abstract: This study is a retrospective analysis of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) data from 56 children with active hydrocephalus and cerebrospinal fluid (CSF) shunt malfunction. The pressures were measured from a separately sited CSF access device placed in the frontal horn of the lateral ventricle. Of the patients, 79% had an elevated ICP (mean 20+/-12 mmHg). A subgroup of patients demonstrated ten different forms of CSF-filled swelling. This group had significantly lower ICP recordings (P=0.000075) with a mean ICP of 8.5 mmHg compared with the remainder (22.9 mmHg). This pressure 'compensation' was because of additional nonphysiological accommodation of CSF volume. Overall the CPP was normal in 35% of cases despite normal ICP occurring in only 11% of cases. The CPPs were not significantly different in those with and without compensation. Measurement of ICP may not always be a reliable indicator of shunt malfunction in shunt-dependent children who present with compensatory CSF-filled spaces.
authors.affiliation: Department of Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK.
authors.forename: C E
authors.initials: CE
authors.lastname: Gilkes
authors.forename: A J
authors.initials: AJ
authors.lastname: Steers
authors.forename: R A
authors.initials: RA
authors.lastname: Minns
mesh_terms: D000293:Adolescent; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D002557:Cerebrospinal Fluid Shunts / Q000295:instrumentation; D002675:Child, Preschool; D004868:Equipment Failure; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D007223:Infant; D007427:Intracranial Pressure / Q000502:physiology*; D008279:Magnetic Resonance Imaging; D008297:Male