90b3d94956359ec64e6c5617fa835485 pmc_33803977.pdf 8a83f639fd86a73fc158dfbbfe0ed1264c19e5ef pmc_33803977.pdf 4e6f1e4c3802339e5060fa9d46b1e4351988a989f765df703a3eee91c2e3c937 pmc_33803977.pdf Title: How to Choose a Shunt for Patients with Normal Pressure Hydrocephalus: A Short Guide to Selecting the BestShunt Assembly Subject: Most patients with hydrocephalus are still managed with the implantation of a cerebrospinal fluid (CSF) shunt in which the CSF flow is regulated by a differential-pressure valve (DPV). Our aim in this review is to discuss some basic concepts in fluid mechanics that are frequently ignored but that should be understood by neurosurgeons to enable them to choose the most adequate shunt for each patient. We will present data, some of which is not provided by manufacturers, which may help neurosurgeons in selecting the most appropriate shunt. To do so, we focused on the management of patients with idiopathic “normal-pressure hydrocephalus” (iNPH), as one of the most challenging scenarios, in which the combination of optimal technology, patient characteristics, and knowledge of fluid mechanics can significantly modify the surgical results. For a better understanding of the available hardware and its evolution over time, we will have a second look at the design of the first DPV and the reasons why additional devices were incorporated to control for shunt overdrainage and its related complications. We try to persuade the reader that a clear understanding of the physical concepts of the CSF and shunt dynamics is key to understand the pathophysiology of iNPH and to improve its treatment. Keywords: differential-pressure valves; hydrocephalus; normal-pressure hydrocephalus; fluid mechanics; shunt overdrainage; antisiphon device Author: Juan Sahuquillo, Katiuska Rosas, Helena Calvo, Aloma Alcina, Dario Gándara, Diego López-Bermeo and Maria-Antonia Poca Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Mon Mar 22 11:23:27 2021 CET ModDate: Mon Mar 22 11:40:34 2021 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 18 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 3524924 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- PSUYZB+VnURWPalladioL Type 1 Custom yes yes no 10 0 YXWKXL+URWPalladioL-Ital Type 1 Custom yes yes no 15 0 CMCLOK+URWPalladioL-Bold Type 1 Custom yes yes no 20 0 QSKRPC+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 ENXZUH+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 36 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 39 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 61 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 65 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 69 0 KPWEJK+CMSY10 Type 1 Builtin yes yes no 84 0 JCEBPL+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 95 0 JCEBPM+PalatinoLinotype CID TrueType Identity-H yes yes yes 98 0 JCEBPN+PalatinoLinotype TrueType WinAnsi yes yes no 104 0 JCEBPP+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 107 0 JCEBPL+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 121 0 JCEBPM+PalatinoLinotype CID TrueType Identity-H yes yes yes 124 0 JCEBPN+PalatinoLinotype TrueType WinAnsi yes yes no 130 0 JCEBPP+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 133 0 JCEBPL+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 144 0 JCEBPM+PalatinoLinotype CID TrueType Identity-H yes yes yes 147 0 JCEBPN+PalatinoLinotype TrueType WinAnsi yes yes no 153 0 JCEBPP+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 156 0 SPXLNH+PazoMath Type 1 Builtin yes yes no 165 0 CZKGAS+CMR10 Type 1 Builtin yes yes no 169 0 QFCIXY+EURM10 Type 1 Builtin yes yes no 173 0 JCEBPL+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 187 0 JCEBPM+PalatinoLinotype CID TrueType Identity-H yes yes yes 190 0 JCEBPN+PalatinoLinotype TrueType WinAnsi yes yes no 196 0 JCEBPP+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 199 0 JCEBPL+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 215 0 JCEBPN+PalatinoLinotype TrueType WinAnsi yes yes no 218 0 JCEBPP+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 221 0 JCEBPL+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 235 0 JCEBPN+PalatinoLinotype TrueType WinAnsi yes yes no 238 0 JCEBPP+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 241 0 JCEBPL+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 253 0 JCEBPN+PalatinoLinotype TrueType WinAnsi yes yes no 256 0 JCEBPP+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 259 0 JCEBPL+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 277 0 JCEBPN+PalatinoLinotype TrueType WinAnsi yes yes no 280 0 JCEBPP+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 283 0 JCEBPL+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 301 0 JCEBPM+PalatinoLinotype CID TrueType Identity-H yes yes yes 304 0 JCEBPN+PalatinoLinotype TrueType WinAnsi yes yes no 310 0 JCEBPP+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 313 0 GEJNTL+VnURWPalladioL-Italic Type 1 Custom yes yes no 332 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-10-02 03:24:59 CEST RepresentationInformation: pmc_33803977.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2023-03-31 12:09:29 CEST Size: 3524924 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 579 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Background Destination: section.1 Item: Title: How Neurosurgeons Select a Shunt? Destination: section.2 Item: Title: Differential-Pressure Valves: The First Generation Destination: section.3 Item: Title: Basic Fluid Mechanics Required to Understand Shunts and Valves Destination: section.4 Item: Title: Which Pressures Govern Cerebrospinal Fluid Flow in an ImplantedShunt Assembly? Destination: section.5 Item: Title: Valve Mechanics and Technology Destination: section.6 Item: Title: Fixed Versus Adjustable Valves Destination: section.7 Item: Title: The Resistance of Shunts and Valves: A Neglected Variable Destination: section.8 Item: Title: Hydrodynamic Properties of Different Shunts Destination: section.9 Item: Title: DPV and Shunt Assemblies for Complex Hydrocephalus Patients Destination: section.10 Item: Title: Conclusions and Recommendations Destination: section.11 Item: Title: References Destination: Item.7 Info: Title: How to Choose a Shunt for Patients with Normal Pressure Hydrocephalus: A Short Guide to Selecting the BestShunt Assembly Author: Juan Sahuquillo, Katiuska Rosas, Helena Calvo, Aloma Alcina, Dario Gándara, Diego López-Bermeo and Maria-Antonia Poca Subject: Most patients with hydrocephalus are still managed with the implantation of a cerebrospinal fluid (CSF) shunt in which the CSF flow is regulated by a differential-pressure valve (DPV). Our aim in this review is to discuss some basic concepts in fluid mechanics that are frequently ignored but that should be understood by neurosurgeons to enable them to choose the most adequate shunt for each patient. We will present data, some of which is not provided by manufacturers, which may help neurosurgeons in selecting the most appropriate shunt. To do so, we focused on the management of patients with idiopathic “normal-pressure hydrocephalus” (iNPH), as one of the most challenging scenarios, in which the combination of optimal technology, patient characteristics, and knowledge of fluid mechanics can significantly modify the surgical results. For a better understanding of the available hardware and its evolution over time, we will have a second look at the design of the first DPV and the reasons why additional devices were incorporated to control for shunt overdrainage and its related complications. We try to persuade the reader that a clear understanding of the physical concepts of the CSF and shunt dynamics is key to understand the pathophysiology of iNPH and to improve its treatment. Keywords: differential-pressure valves; hydrocephalus; normal-pressure hydrocephalus; fluid mechanics; shunt overdrainage; antisiphon device Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Mon Mar 22 11:23:27 CET 2021 ModDate: Mon Mar 22 11:40:34 CET 2021 ID: 0x5100ad9c045ef5287779939b3a466bec, 0x5100ad9c045ef5287779939b3a466bec Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: CMCLOK+URWPalladioL-Bold FontSubset: true FirstChar: 3 LastChar: 122 FontDescriptor: FontName: CMCLOK+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: KPWEJK+CMSY10 FontSubset: true FirstChar: 0 LastChar: 21 FontDescriptor: FontName: KPWEJK+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true Font: BaseFont: SPXLNH+PazoMath FontSubset: true FirstChar: 87 LastChar: 87 FontDescriptor: FontName: SPXLNH+PazoMath Flags: Symbolic FontBBox: -40, -283, 878, 946 FontFile: true Font: 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