Citation

Deininger MH, Weyerbrock A. Acta Neurochir. (Wien) 2009; 151(6): 705-709; discussion 709.

Copyright

(Copyright © 2009, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00701-009-0291-8

PMID

19337679

Abstract

BACKGROUND: In the subgroup of bedridden hydrocephalic patients with ventriculo-peritoneal shunts and gravitational valves, we occasionally observed persisting hydrocephalic complaints even when mechanical or infection-related obstruction was excluded.
METHODS: To investigate the cause of these hydrocephalic symptoms, in vitro and in vivo analyses were used to determine valve opening, intra-abdominal and hydrostatic pressure of an Aesculap-Miethke 10/40 cm H2O gravitational valve at different angles of upper body and head inclination.
FINDINGS: Since hydrostatic pressure is lacking, the resulting intra-ventricular pressures are shown to peak up to 27 cm H2O in supine patients with head, but not upper body inclined.
CONCLUSIONS: We conclude that in the subgroup of bedridden patients with ventriculo-peritoneal shunts and gravitational valves, upright posture is a prerequisite for proper cerebrospinal fluid drainage.

Language: en

Keywords

Adolescent; Akinetic Mutism; Brain Injuries; Cerebrospinal Fluid Pressure; Craniotomy; Female; Gravitation; Head Injuries, Closed; Humans; Hydrocephalus; Intracranial Hypotension; Intracranial Pressure; Posture; Subarachnoid Hemorrhage; Suicide, Attempted; Supine Position; Surgical Instruments; Ventriculoperitoneal Shunt