Outcome After Surgery
- ICP monitoring guides treatment: One study (15) reported the ICP monitoring results for 23 shunted patients experiencing headaches who were all improved after shunt revision. Of these, 12 showed overdrainage preoperatively, while 3 patients had high ICPs prior to shunt revision. In a smaller series of 12 patients, 10 improved with intervention (17).
- Low-pressure headaches: The addition of antisiphon devices to a functioning shunt to prevent overdrainage decreased the number of revisions, and symptoms were less frequent in one reported series (10).
- Elevated ICP and shunt malfunction: ETV has been used as an alternative to shunt revision in this setting. Chernov et al. (14) reported that15 patients became shunt independent after receiving an ETV. In another series (12), 14 of 22 patients were no longer shunt dependent after undergoing an ETV. In yet another series, 27 of 33 patients who presented with malfunctioning shunts and slit ventricles were successfully converted to lumboperitoneal shunts after ETV when communication was observed between ventricles and subarachnoid space (15).
- Cranial decompression: Subtemporal decompression and cranial expansion can lower ICP. However, in one series the number of shunt revisions increased (19).
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