There are different opinion: I would like to quote from the following link one:
https://www.aliem.com/tips-for-interpreting-the-csf-opening-pressure/
"The normal range for CSF is reported differently in various sources, with most reporting a normal range of 7-18 cmH2O in adults,1 though some consider the normal range 5-25 cmH2O.2 However, a pressure >25 cmH2O or
Is defining CSF pressure is significant practically?
Surely it is, but it can be decieving in management and adjustment. Curve of normal distribution (Bell curve) is insignficant in the individual patient. To clarify if my CSF normal pressure is 18, this is a very sensitive number for me. I might be symptomatic if I have gone little above or below it and I would be symptomatic. So I canot say that if my CSF pressure is 7 I would be in the normal range. At 7, I Omer might be seriously overdraining.
What should follow here is the question about the factors which make this individuality in different persons.
The main problem we have in management are 2:
1) To know what is the specific normal CSF pressue for a certain patient. We do not have clear indicators yet.
2) How to come to this point in a correct and safe plan which should include draining CSF collected inside brain matter and also to avoid as much overdrainage as we can.
Equations like those used in body fluid balance are needed. These equations as well as clinical indicators are helping physicians and pediatricians to avoid overhydration and dehydration achieving normal body fluid balance.
Omer, did you have an experience with a shunting that the location of the tube in the head was different from conventional shunting? For example, the tube inserts to the ventricular system around Magna (back of the head) instead of the common places of tubes (lateral sides of the head).
Do you think this can be effective in opening pressure and NR?
Placing the catheter tip in a good place is considered by neurosurgeons an important point in proper shunt function dear Seifoallah. Another point for consideration is the length of peritoneal catheter.
In case you put the following in search box you will get more results:
Ventricular catheter projects in vp shunt
My best regards
Regarding your question; my ventricular catheter is anterior and the tip is near to the foramen of Monoro. Neurosurgeons claim that this is a good place. It is devoid of choroid plexus which has the potential of making adhesions blocking the tip of catheter. Some neurosurgeons say also there are eddies of csf at this site which helps csf drainage.
Back side insertion I think it is unfavourable. But it is better to discuss this point with neurosurgeons.
@Joon W Shim:
NR stands for "normal range" upon which diagnosis of increased or decreased CSF pressure is based on. CSF pressure measurement can help in diagnosing things like intracranial hypertension or hypotension. Also it helps in valve adjustment in shunted patients. It needs to be known in standing and supine positions if possible, but this would be invasive and not practical. I think research is going on to find a non-invasive measure which is dependable and easy, like a syphgomanometer or a glucometer. Success of hydrocephalus treatment will depend on optimal valve adjustment. I believe that little above or below the optimal is not favourable.
To ameliorate symptoms and to prolong shunt life we need to be optimal.
My best regards,
Omer
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