The Relationship between Ventricular Fluid Pressure and Body Position in Normal Subjects and Subjects with Shunts: A Telemetric Study

Chapman, Paul H.; Cosman, E.R.; Arnold, M.

doi:10.1227/00006123-199002000-00001

Cited by 183 publications

(116 citation statements)

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“…we may be unable to demonstrate 'true' significant differences. Another limitation is that we did not have access to 24-h monitoring data on ICP, which is known to change according to the position of the head and in the course of the day (22)(23)(24), so that it should be monitored continuously for at least 24 h to get reliable information on its mean level (25)(26)(27). The present patients were referred to our hospital when they had symptoms and signs of increased ICP and it was not considered ethically acceptable to wait for the results of continuous ICP monitoring, but rather they were operated on as soon as a diagnosis of hydrocephalus had been confirmed by other means.…”

Section: Discussionmentioning

confidence: 99%

Pituitary function in children with hydrocephalus before and after the first shunting operation

Löppönen

Al²,

Serlo³

et al. 1998

European Journal of Endocrinology

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Objective: Children with shunted hydrocephalus experience slow linear growth in prepuberty, accelerated pubertal maturation and a reduced final height. A substantial proportion of these patients have a poor growth hormone (GH) response to stimulation and reduced pituitary volume. The basic mechanisms behind these phenomena are still unknown, but one can hypothesize that an unphysiological intracranial pressure (ICP) may be involved. This study was undertaken to investigate the effect of increased ICP on pituitary function. Design: Twenty-one children (nine males) aged 4 months to 15 years were evaluated for pituitary function before and after their first shunting operation. Methods: A clinical examination was performed, bone age was determined and a combined pituitary stimulation test was performed to evaluate GH, luteinizing hormone, follicle-stimulating hormone, cortisol, thyrotropin and prolactin secretion. Results: GH concentrations were significantly higher 10 and 15 min before the operation (P=0.04 and P=0.03 respectively) than after it. The basal levels of insulin-like growth factor-I (IGF-I) tended to be higher before the operation than afterwards and those of its binding protein-3 (IGFBP-3) were significantly so (P<0.01). Conclusions: The higher GH response to GH releasing hormone and circulating IGFBP-3 levels in children with hydrocephalus before compared with after their first shunting operation raise the possibility that the reduced GH secretion and retarded linear growth observed in children with shunted hydrocephalus may be a consequence of decreased ICP and/or the lack of physiological pressure variations.

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Section: Discussionmentioning

confidence: 99%

Pituitary function in children with hydrocephalus before and after the first shunting operation

Löppönen

Al²,

Serlo³

et al. 1998

European Journal of Endocrinology

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“…4,21 Efforts have been made to determine intracranial pressure as a relevant pathophysiological and diagnostic factor for hydrocephalus. 2,5,10,19,23 In contrast, determination of intraperitoneal pressure (IPP) as part of the preoperative assessment remains neglected and is still debated in the literature. Reported values range from subatmospheric to 15-25 cm H 2 O regardless of the intraperitoneal location, reference level, body position, and measurement technique.…”

Section: ©Aans 2013mentioning

confidence: 99%

Differential pressure in shunt therapy: investigation of position-dependent intraperitoneal pressure in a porcine model

Freimann¹,

Ötvös²,

Chopra

et al. 2013

PED

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Object The differential pressure between the intracranial and intraperitoneal cavities is essential for ventriculoperitoneal shunting. A determination of the pressure in both cavities is decisive for selecting the appropriate valve type and opening pressure. The intraperitoneal pressure (IPP)—in contrast to the intracranial pressure—still remains controversial with regard to its normal level and position dependency. Methods The authors used 6 female pigs for the experiments. Two transdermal telemetric pressure sensors (cranial and caudal) were implanted intraperitoneally with a craniocaudal distance of 30 cm. Direct IPP measurements were supplemented with noninvasive IPP measurements (intragastral and intravesical). The IPP was measured with the pigs in the supine (0°), 30°, 60°, and vertical (90°) body positions. After the pigs were euthanized, CT was used to determine the intraperitoneal probe position. Results With pigs in the supine position, the mean (± SD) IPP was 10.0 ± 3.5 cm H2O in a mean vertical distance of 4.5 ± 2.8 cm to the highest level of the peritoneum. The difference between the mean IPP of the cranially and the caudally implanted probes (Δ IPP) increased according to position, from 5.5 cm H2O in the 0° position to 11.5 cm H2O in the 30° position, 18.3 cm H2O in the 60° position, and 25.6 cm H2O in the vertical body position. The vertical distance between the probe tips (cranially implanted over caudally implanted) increased 3.4, 11.2, 19.3, and 22.3 cm for each of the 4 body positions, respectively. The mean difference between the Δ IPP and the vertical distance between both probe tips over all body positions was 1.7 cm H2O. Conclusions The IPP is subject to the position-dependent hydrostatic force. Normal IPP is able to reduce the differential pressure in patients with ventriculoperitoneal shunts.

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“…15,27 Intracranial pressure studies at different tilt angles have shown that there is a faster reduction of ICP at smaller angles and a slower reduction at higher angles. 2,8,73 In healthy subjects, with upright posture there is a drop in ICP ranging between -5 and 5 cm H 2 O with reference to the foramen magnum.…”

mentioning

confidence: 99%

“…54 In contrast, in patients harboring shunts without antisiphon devices, pressures range from -15 to -35 cm H 2 O when they are upright. 15,41,45 One method that allows us to quantify the cerebral venous pressure component of ICP during CSF diversion is Davson's steady-state formula, 23 …”

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confidence: 99%

Cerebral venous overdrainage: an under-recognized complication of cerebrospinal fluid diversion

Barami

2016

FOC

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Understanding the altered physiology following cerebrospinal fluid (CSF) diversion in the setting of adult hydrocephalus is important for optimizing patient care and avoiding complications. There is mounting evidence that the cerebral venous system plays a major role in intracranial pressure (ICP) dynamics especially when one takes into account the effects of postural changes, atmospheric pressure, and gravity on the craniospinal axis as a whole. An evolved mechanism acting at the cortical bridging veins, known as the “Starling resistor,” prevents overdrainage of cranial venous blood with upright positioning. This protective mechanism can become nonfunctional after CSF diversion, which can result in posture-related cerebral venous overdrainage through the cranial venous outflow tracts, leading to pathological states. This review article summarizes the relevant anatomical and physiological bases of the relationship between the craniospinal venous and CSF compartments and surveys complications that may be explained by the cerebral venous overdrainage phenomenon. It is hoped that this article adds a new dimension to our therapeutic methods, stimulates further research into this field, and ultimately improves our care of these patients.

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The Relationship between Ventricular Fluid Pressure and Body Position in Normal Subjects and Subjects with Shunts: A Telemetric Study

Cited by 183 publications

References 0 publications

Pituitary function in children with hydrocephalus before and after the first shunting operation

Pituitary function in children with hydrocephalus before and after the first shunting operation

Differential pressure in shunt therapy: investigation of position-dependent intraperitoneal pressure in a porcine model

Cerebral venous overdrainage: an under-recognized complication of cerebrospinal fluid diversion

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