CSF Overdrainage

Despite modifications of valve design including on/off control, anti-siphon devices and, more recently, externally programmable valves, shunts cannot reproduce the balance between CSF production and absorption characteristic of normal physiology. Excessive CSF drainage may result in symptoms of headache, nausea and vomiting, diplopia and a generalized lethargy, sometimes with impairment of school performance. These symptoms can be difficult to distinguish from raised ICP. Resolution of symptoms on lying down is an occasional indicator favoring intracranial hypotension.

The consequences of overdrainage include subdural hematoma formation. This may vary from mild extra-axial collections that are often managed conservatively, to larger symptomatic subdural hematomas that may necessitate intervention. Treatment strategies may include burr hole drainage with or without shunt removal, upgrading the valve to a higher pres

Table 24.3. Commonly encountered complications of shunts. Complication Infection

Shunt blockage (proximal, valve, distal) Fracture or disconnection Migration Overdrainage

Isolation (trapping) of ventricles Malposition

Intracranial haemorrhage Viscus perforation

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