title: Acute ventriculoperitoneal shunt malfunction following opening of the spinal subarachnoid space: a case series.
abstract: BACKGROUND
  Malfunction of cerebrospinal shunts is common and due to multiple etiologies. We hypothesize that opening of the spinal dura may prompt shunt failure in select individuals with previously unrecognized tenuous shunt function.
  
  
  METHODS
  The authors describe five patients with shunted hydrocephalus who underwent procedures in which the spinal dura mater was opened. All patients had acute dysfunction of their ventriculoperitoneal shunt that required shunt revision. All shunt valves were functioning properly at operative inspection but all patients were found to have adherent intracranial catheters with ingrowth of choroid plexus.
  
  
  CONCLUSIONS
  We theorize that the siphoning effect caused from cerebrospinal fluid egress from the opened spinal subarachnoid space resulted in acute shunt failure. Such alterations in cerebrospinal fluid flow may precipitate complete failure of a shunt that is functioning suboptimally. Clinicians should be aware that spinal procedures that violate the subarachnoid space in shunted hydrocephalic patients may result in acute shunt failure. These patients may warrant more careful observation in the early postoperative period, particularly as shunt failure may compromise spinal wound closures.
authors.affiliation: Section of Pediatric Neurosurgery, Children's Hospital, ACC 400, 1600 7th Ave South, Birmingham, AL 35233, USA. rstubbs@uab.edu
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Pugh
authors.forename: Leslie
authors.initials: L
authors.lastname: Acakpo-Satchivi
authors.forename: John C
authors.initials: JC
authors.lastname: Wellons
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Blount
authors.forename: W Jerry
authors.initials: WJ
authors.lastname: Oakes
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002831:Choroid Plexus / Q000473:pathology* / Q000601:surgery; D004868:Equipment Failure; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D008297:Male; D013346:Subarachnoid Space / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods