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Effect of cerebrospinal fluid shunts on intracranial pressure and on cerebrospinal fluid dynamics
  1. John L. Fox,
  2. David C. McCullough,
  3. Robert C. Green
  1. Section of Neurosurgery, The Veterans Administration Hospital, Washington, D.C., U.S.A.
  2. The George Washington University, Washington, D.C., U.S.A.
  3. Georgetown University Schools of Medicine, Washington, D.C., U.S.A.

    2. A new technique of pressure measurements: results and concepts1 3.A concept of hydrocephalus

    Abstract

    Part 2 describes measurements of intracranial cerebrospinal fluid (CSF) pressure in 18 adult patients with CSF shunts, all pressure measurements being referred to a horizontal plane close to the foramina of Monro. All 18 patients had normal CSF pressure by lumbar puncture; however, in one patient an intracranial pressure of +280 mm was subsequently measured after pneumoencephalography. Twelve patients had pre-shunt CSF pressures measured intracranially: 11 ranged from +20 to +180 mm H2O and one was +280 mm H2O in the supine position. In the upright posture nine patients had values of −10 to −140 mm H2O, while three others were +60, +70, and +280 mm H2O. After CSF shunting in these 18 patients the pressures were −30 to +30 mm H2O in the supine position and −210 to −370 mm in the upright position. The effect of posture on the siphoning action of these longer shunts in the erect, adult patient is a major uncontrollable variable in maintenance of intracranial pressure after shunting. Other significant variables are reviewed. In Part 3 a concept of the hydrocephalus phenomenon is described. Emphasis is placed on the pressure differential (Pd) and force differential (Fd) causing pre-shunt ventricular enlargement and post-shunt ventricular size reduction. The site of Pd, which must be very small and not to be confused with measured ventricular pressure, P, must be at the ventricular wall.

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    2. A new technique of pressure measurements: results and concepts1 3.A concept of hydrocephalus

    Footnotes

    • 1 This study was supported by a grant to Neurosurgical Research Unit 102.80 of the U.S. Veterans Administration.

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