Hydrocephalus and the reproductive health of women: The medical implications of maternal shunt dependency in 70 women and 138 pregnancies

Liakos, A M; Bradley, Nancy; Magram, Gary; Muszynski, Charles

doi:10.1080/01616412.2000.11741040

Cited by 52 publications

(34 citation statements)

References 12 publications

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“…However, these theoretical concerns appear to be unfounded [53]. Case reports also indicate that in pregnant patients with preexisting CSF shunts, proper management can lead to normal pregnancy, and decisions regarding the mode of delivery, anesthesia, and analgesia should be based only on obstetric concerns [20,42,[53][54][55].…”

Section: Anesthesia Concerns During Delivery Of the Fetusmentioning

confidence: 98%

Medical and surgical management of idiopathic intracranial hypertension in pregnancy

Tang

Dorotheo

Schiffman³

et al. 2004

Curr Neurol Neurosci Rep

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Idiopathic intracranial hypertension (IIH) is a syndrome of increased intracranial pressure without hydrocephalus or mass lesion with elevated cerebrospinal fluid (CSF) pressure but otherwise normal CSF composition. It has been found that pregnancy occurs in IIH patients at about the same rate as in the general population, that IIH can occur in any trimester of pregnancy, that patients have the same spontaneous abortion rate as the general population, and that the visual outcome is the same as for nonpregnant patients with IIH. Although it is also stated that pregnant patients with IIH should be managed and treated the same way as any other patient with IIH, the use of imaging and drug contraindications do make a difference between the two groups. The treatment has two major goals, which are to preserve vision and to improve symptoms. The medical therapy includes weight control, nonketotic diet, serial lumbar punctures, diuretics, steroids, and certain analgesics. When medical therapy fails, surgical procedures should be considered. The two main procedures are optic nerve sheath fenestration and lumboperitoneal shunt. Anesthetic considerations in the pregnant patient are an additional factor when surgeries are contemplated. It is also noted that therapeutic abortion to limit progression of disease is not indicated and that subsequent pregnancies do not increase the risk of recurrence.

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Section: Anesthesia Concerns During Delivery Of the Fetusmentioning

confidence: 98%

Medical and surgical management of idiopathic intracranial hypertension in pregnancy

Tang

Dorotheo

Schiffman³

et al. 2004

Curr Neurol Neurosci Rep

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“…Although management of hydrocephalus during pregnancy has been described, [1][2][3][4] we could find no mention in the literature of treatment of life-threatening acute hydrocephalus in a pregnant woman. VP shunt malfunction is not unexpected during pregnancy.…”

Section: Discussionmentioning

confidence: 90%

“…4 In these patients proper management and close collaboration with the neurosurgeon, obstetrician and anesthesiologist offer the best chance of normal pregnancy and delivery. 3,6 Diagnosis of hydrocephalus from shunt malfunction may not be easy during pregnancy. As headaches occur more frequently in the late stages of pregnancy, 6 symptoms of increased intracranial pressure (ICP) may be misdiagnosed as normal.…”

Section: Discussionmentioning

confidence: 99%

“…Some reviewers reported a higher incidence of complications with VP shunts than with other types of shunts at this time. [2][3][4] The main causes are increased total body water and intracranial CSF volume, 5 decreased plasma osmotic pressure and an increase in intraabdominal pressure by the enlarging uterus. 4 In these patients proper management and close collaboration with the neurosurgeon, obstetrician and anesthesiologist offer the best chance of normal pregnancy and delivery.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Anesthesia for urgent sequential ventriculoperitoneal shunt revision and cesarean delivery

Freo

Pitton

Carron

et al. 2009

International Journal of Obstetric Anesthesia

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“…This group subsequently extended their observations to 138 pregnancies among 70 women. 51 The authors drew attention to the months after delivery as a period of potential shunt instability.…”

Section: Hydrocephalusmentioning

confidence: 99%

Treatment of myelomeningocele: a review of outcomes and continuing neurosurgical considerations among adults

Piatt¹

2010

PED

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Object Myelomeningocele is the most severe congenital malformation of the CNS that is compatible with survival. From the time of the development of practical treatment for hydrocephalus in the late 1950s, affected individuals began to survive into adulthood in substantial numbers. Data on the neurological status of these individuals are sparse, as are descriptions of their continuing requirements for neurosurgical care. Methods A review of the literature was undertaken using the PubMed database maintained by the National Library of Medicine. Formal grading of the quality of evidence was not attempted, but methodological issues affecting validity or generalizability were noted. Results Observations from 2 major longitudinal studies of cohorts of patients treated without selection using contemporary neurosurgical techniques have been published at intervals beginning in the mid-1970s. Numerous cross-sectional, institutional reviews have focused on neurosurgical issues in adulthood: hydrocephalus, Chiari malformation Type II and syringomyelia, and secondary spinal cord tethering. The organization of medical services for adults with myelomeningocele has received limited study. Conclusions Surviving adults with myelomeningocele achieve a wide range of neurological and functional outcomes, the most critical and adverse determinant of which is symptomatic CSF shunt failure. From a neurosurgical standpoint, adults with myelomeningocele remain clinically active indefinitely, and they deserve periodic neurosurgical surveillance.

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Hydrocephalus and the reproductive health of women: The medical implications of maternal shunt dependency in 70 women and 138 pregnancies

Cited by 52 publications

References 12 publications

Medical and surgical management of idiopathic intracranial hypertension in pregnancy

Medical and surgical management of idiopathic intracranial hypertension in pregnancy

Anesthesia for urgent sequential ventriculoperitoneal shunt revision and cesarean delivery

Treatment of myelomeningocele: a review of outcomes and continuing neurosurgical considerations among adults

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