As I got no single response on my contribution on anti-siphoning; I am trying to trigger the discussion in an opposite way. Hydrocephalus is a potentially curable disease, but results are only fairly good. So if you think that siphoning can be useful: how do we can do it effectively and safely?
How we can calculate the amount of CSF needed to be siphoned? How much time interval is expected before repeating it? Can it be done through a shunt? What are the precautions?
Yes, it is frequently done through a shunt. I have observed people who have lived with hydrocephalus well into adulthood who still have a shunt. Regulation of CSF extraction is determined the amount of pressure on the brain. often done by using a intercranial pressure monitor, CT or MRI scan, or CSF fluid evaluation. Shunting is still the standard of care for this condition. There are usually minimal complications, but someone should monitor the integrity of the shunt and the tissue around it.
Hello Dr. B Barton and thank you too much for your sharing. I believe that your observations are very correct. Shunting is the only available treatment nowadays for hydrocephalus. Also neurosurgeons are very skilled and very cautious in implanting shunts. They shifted from standard valves to programmable valves for better adjustment of optimal CSF pressure. You must be also aware of this, and fully aware of risks of adjustment. Neurosurgeons are declaring it very clearly and very honestly to their patients. Not all hydrocephalus patients are the same. I am not sure, but I think many patients are easily adjusted. But I am very sure that they have problems with others. I believe that they do not have sensitive indicators to the optimal CSF pressure in some patients. I do not think CT or MRI or CSF fluid are giving them enough data. The problem in CSF pressure monitoring as an indicator is that there is no known normal CSF numbers. CSF pressure measurement is not like BP pressure monitoring because they do not know what is normal for a certain patient. I am sure that research is going on these points and hopefully they will come to an answer in the near future. Work on this point is very sensitive and could be dangerous. They are moving cautiously to ensure patients safety. No neurosurgeon would accept to sacrifice a patient for a better adjustment. The problem also is that a compromise is not the correct answer in CSF adjustment. Ideally it should be optimal. This gives a complete cure (reversible dementia) in many patients and also it prolongs shunt life. This is my understanding of the problem, and I hope you can clarify it more to me. Best regards
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