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Review

How to Choose a Shunt for Patients with Normal Pressure Hydrocephalus: A Short Guide to Selecting the Best Shunt Assembly

1
Department of Neurosurgery, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
2
Neurotrauma and Neurosurgery Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
3
Department of Surgery, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
*
Author to whom correspondence should be addressed.
Academic Editor: Giuseppe Lanza
J. Clin. Med. 2021, 10(6), 1210; https://doi.org/10.3390/jcm10061210
Received: 6 February 2021 / Revised: 6 March 2021 / Accepted: 8 March 2021 / Published: 15 March 2021
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. View Full-Text
Keywords: differential-pressure valves; hydrocephalus; normal-pressure hydrocephalus; fluid mechanics; shunt overdrainage; antisiphon device differential-pressure valves; hydrocephalus; normal-pressure hydrocephalus; fluid mechanics; shunt overdrainage; antisiphon device
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MDPI and ACS Style

Sahuquillo, J.; Rosas, K.; Calvo, H.; Alcina, A.; Gándara, D.; López-Bermeo, D.; Poca, M.-A. How to Choose a Shunt for Patients with Normal Pressure Hydrocephalus: A Short Guide to Selecting the Best Shunt Assembly. J. Clin. Med. 2021, 10, 1210. https://doi.org/10.3390/jcm10061210

AMA Style

Sahuquillo J, Rosas K, Calvo H, Alcina A, Gándara D, López-Bermeo D, Poca M-A. How to Choose a Shunt for Patients with Normal Pressure Hydrocephalus: A Short Guide to Selecting the Best Shunt Assembly. Journal of Clinical Medicine. 2021; 10(6):1210. https://doi.org/10.3390/jcm10061210

Chicago/Turabian Style

Sahuquillo, Juan, Katiuska Rosas, Helena Calvo, Aloma Alcina, Dario Gándara, Diego López-Bermeo, and Maria-Antonia Poca. 2021. "How to Choose a Shunt for Patients with Normal Pressure Hydrocephalus: A Short Guide to Selecting the Best Shunt Assembly" Journal of Clinical Medicine 10, no. 6: 1210. https://doi.org/10.3390/jcm10061210

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