How to define CSF overdrainage: a systematic literature review

Research output: Contribution to journalJournal articleResearchpeer-review

  • Sarah Hornshoej Pedersen
  • Tobias Hannibal Prein
  • Ahmed Ammar
  • André Grotenhuis
  • Mark G. Hamilton
  • Torben Skovbo Hansen
  • Uwe Kehler
  • Harold Rekate
  • Ulrich Wilhelm Thomale
  • Juhler, Marianne

Purpose: Overdrainage (OD) is one of the most frequent complications related to drainage of the cerebrospinal fluid (CSF). It is mostly associated with valve-bearing shunt systems but should probably be considered as a risk factor in any type of CSF diversion procedure. There is extreme variation in the reported incidence of OD due to the lack of consensus on defining criteria and an unclear perception of the pathophysiology. Hence, OD is probably underreported and underestimated. The objective of this paper was to establish a definition of OD, based on a systematic review of the literature. Methods: A systematic search was conducted in MEDLNE and EMBASE. Studies providing a definition or a description of diagnostic findings related to OD in ventriculoperitoneal shunt treated hydrocephalus were included. Non-English titles, abstracts and manuscripts were excluded. Extracted descriptions were graded into five groups (class I-V studies) based on how precise the terminology used to describe OD was. Class I studies were included for further analysis and characteristics of OD were extracted. The quality of included descriptions was assessed by a clinical expert panel. Results: A total of 1309 studies were screened, 190 were graded into groups, and 22, which provided specific definitions or descriptions of OD, were graded as class I studies. We extracted 32 different characteristics consistent with OD (e.g., clinical symptoms, radiological signs, and syndromes). Conclusion: There was an overall agreement that CSF overdrainage following implantation of a ventriculoperitoneal shunt in a mixed pediatric and adult population is characterized as a persistent condition with clinically manifestations as postural dependent headache, nausea, and vomiting and/or radiological signs of slim ventricles and/or subdural collections.

Original languageEnglish
JournalActa Neurochirurgica
Volume165
Issue number2
Pages (from-to)429-441
Number of pages13
ISSN0001-6268
DOIs
Publication statusPublished - 2023

Bibliographical note

Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.

    Research areas

  • CSF shunting, Excessive CSF drainage, Hyperdrainage, Overdrainage, Overshunting, VP shunting

ID: 363553913