Paradoxical response of intracranial pressure to shunt valve setting adjustments

• Published in: Acta neurochirurgica 2020-10, Vol.162 (10), p.2451-2458
• Main Authors: D’Antona, Linda, Craven, Claudia Louise, Merchan, Melida Andrea Jaime, Thompson, Simon David, Bremner, Fion, Thorne, Lewis, Matharu, Manjit Singh, Watkins, Laurence Dale, Toma, Ahmed Kassem
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Catheters - adverse effects; Cerebrospinal fluid; Cerebrospinal fluid shunts; Cerebrospinal Fluid Shunts - adverse effects; CSF Circulation; Female; Humans; Hydrocephalus; Hydrocephalus - complications; Hydrocephalus - surgery; Hydrodynamics; Interventional Radiology; Intracranial Pressure; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Monitoring, Physiologic; Neurology; Neuroradiology; Neurosurgery; Original - CSF Circulation; Original Article - CSF Circulation; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Pseudotumor Cerebri - complications; Shunts; Surgical Orthopedics; Symptom management
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-020-04462-y

Background The hydrodynamics of cerebrospinal fluid shunts have been described in vitro; however, knowledge on the response of intracranial pressure (ICP) to valve settings adjustments in vivo is limited. This study describes the effect of adjusting the shunt valve setting on ICP in a cohort of patients with complex symptom management. Method Single-centre retrospective observational study. Patients who underwent ICP-guided valve setting adjustments during 24-h continuous ICP monitoring, between 2014 and 2019, were included. Patients with suspected shunt malfunction were excluded. Median night ICP before and after the valve adjustments were compared (Δ night ICP). The responses of ICP to valve adjustment were divided into 3 different groups as follows: expected, paradoxical and no response. The frequency of the paradoxical response and its potential predicting factors were investigated. Results Fifty-one patients (37 females, 14 males, mean age 38 years) receiving 94 valve setting adjustments met the study inclusion criteria. Patients’ underlying conditions were most commonly hydrocephalus (47%) or idiopathic intracranial hypertension (43%). The response of ICP to valve setting adjustments was classified as ‘expected’ in 54 cases (57%), ‘paradoxical’ in 17 cases (18%) and ‘no effect’ (Δ night ICP