Elsevier

World Neurosurgery

Volume 109, January 2018, Pages 372-376
World Neurosurgery

Case Report
Progressive Functional Underdrainage in Cerebrospinal Fluid Shunt-Dependent Women During Pregnancy: Case Report and Review of the Literature

https://doi.org/10.1016/j.wneu.2017.09.108Get rights and content

Background

Since the 1950s cerebrospinal fluid (CSF) shunt dependency has no longer been a contradiction to normal life, including sexuality and pregnancy in women, because of advances in the understanding of hydrocephalus and shunt technology. Although pregnancy in shunt-dependent women is rare, it causes uncertainty among treating physicians.

Case Description

We report the case of a 34-year-old pregnant woman with a ventriculoperitoneal shunt. Throughout her pregnancy she experienced progressive symptoms of CSF underdrainage without any signs of other pregnancy-related complications. After the delivery of a healthy infant, shunt resistance had to be readjusted to prepregnancy levels. A comprehensive review of the literature reports in English, listed in PubMed, is provided.

Conclusions

Conservative treatment of pregnancy-related functional underdrainage by consecutive valve pressure adjustment is possible, easy, and safe.

Introduction

Because of advances in the treatment of hydrocephalic patients since the 1960s, women with hydrocephalus nowadays may live normal lives, including sexuality and pregnancy. Thus, obstetricians and neurosurgeons encounter pregnant women with cerebrospinal fluid (CSF) diversion devices more often. Still, there are often questions among physicians regarding management during pregnancy. Early symptoms of elevated intracranial pressure (ICP), such as headache, nausea, and vomiting, regularly occur during the course of pregnancy. A precise differentiation between shunt dysfunction and pregnancy-related symptoms is important to minimize the risk to mother and child resulting from ICP exacerbation or unnecessary surgical shunt revisions. Some cases of shunt dysfunctions during pregnancy are reported in the literature, but their natural history still remains unclear. We report the case of a 34-year-old secundipara woman with a ventriculoperitoneal (VP) shunt who showed progressive need of elevated CSF drainage during pregnancy, returning to prepregnancy status just after delivery, along with a PubMed review of the English literature. To our knowledge, this is the only reported case of conservative treatment by consecutive change of valve pressure level correlating pregnancy progression and valve pressure.

Section snippets

Case Report

A 34-year-old woman, para 1, gravida 2, was followed up at the department of neurosurgery at the University hospital of Zurich, Switzerland. Early in her childhood she received the diagnosis of a congenital communicating hydrocephalus and was treated with a VP shunt. She subsequently underwent several shunt revisions. Her condition was complicated by a slit-ventricle syndrome, which is common among patients treated with shunt systems not actively countering the siphoning effect during childhood

Overview of Published Cases

Pregnancy in women with CSF diversion devices still remains a rare constellation. Consequently, our knowledge is mostly based on case reports and several case series. In 1979 the first 2 cases of hydrocephalic women observed during pregnancy were reported.1 The largest published case series retrospectively analyzed 138 pregnancies in 70 shunt-dependent women.2 Conclusions were drawn from a detailed autoquestionnaire. To date, 117 shunt-dependent women with 204 pregnancies have been reported in

Conclusion

In CSF shunt-dependent women, pregnancy-related changes in the CSF drainage equilibrium can occur and become symptomatic. CSF underdrainage can quickly be managed by adjustment of the valve pressure level, avoiding invasive procedures. Physicians should be vigilant to discriminate hydrocephalic from pregnancy-related symptoms. In young female patients, adjustable gravitational units could facilitate conservative management during pregnancy. Therefore, the implantation of such devices should be

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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