{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T00:27:39Z","timestamp":1793838459518,"version":"4.6.1"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2020,6,24]],"date-time":"2020-06-24T00:00:00Z","timestamp":1592956800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,6,24]],"date-time":"2020-06-24T00:00:00Z","timestamp":1592956800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000765","name":"University College London","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000765","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>The hydrodynamics of cerebrospinal fluid shunts have been described in vitro; however, knowledge on the response of intracranial pressure (ICP) to valve settings adjustments in vivo is limited. This study describes the effect of adjusting the shunt valve setting on ICP in a cohort of patients with complex symptom management.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Method<\/jats:title>\n<jats:p>Single-centre retrospective observational study. Patients who underwent ICP-guided valve setting adjustments during 24-h continuous ICP monitoring, between 2014 and 2019, were included. Patients with suspected shunt malfunction were excluded. Median night ICP before and after the valve adjustments were compared (\u0394 night ICP). The responses of ICP to valve adjustment were divided into 3 different groups as follows: expected, paradoxical and no response. The frequency of the paradoxical response and its potential predicting factors were investigated.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Fifty-one patients (37 females, 14 males, mean age 38\u00a0years) receiving 94 valve setting adjustments met the study inclusion criteria. Patients\u2019 underlying conditions were most commonly hydrocephalus (47%) or idiopathic intracranial hypertension (43%). The response of ICP to valve setting adjustments was classified as \u2018expected\u2019 in 54 cases (57%), \u2018paradoxical\u2019 in 17 cases (18%) and \u2018no effect\u2019 (\u0394 night ICP &lt;\u20091\u00a0mmHg) in 23 cases (24%). There was a significant correlation between the \u0394 night ICP and the magnitude of valve setting change in both the investigated valves (Miethke ProGAV, <jats:italic>p<\/jats:italic>\u2009=\u20090.01 and Medtronic Strata, <jats:italic>p<\/jats:italic>\u2009=\u20090.02).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Paradoxical ICP changes can occur after shunt valve setting adjustments. This observation should be taken into account when performing ICP-guided valve adjustments and is highly relevant for the future development of \u201csmart\u201d shunt systems.<\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s00701-020-04462-y","type":"journal-article","created":{"date-parts":[[2020,6,24]],"date-time":"2020-06-24T15:03:31Z","timestamp":1593011011000},"page":"2451-2458","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Paradoxical response of intracranial pressure to shunt valve setting adjustments"],"prefix":"10.1007","volume":"162","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9918-5225","authenticated-orcid":false,"given":"Linda","family":"D\u2019Antona","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Louise","family":"Craven","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melida Andrea Jaime","family":"Merchan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon David","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fion","family":"Bremner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lewis","family":"Thorne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjit Singh","family":"Matharu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence Dale","family":"Watkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Kassem","family":"Toma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,6,24]]},"reference":[{"key":"4462_CR1","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/1743-8454-3-9","volume":"3","author":"DM Allin","year":"2006","unstructured":"Allin DM, Czosnyka ZH, Czosnyka M, Richards HK, Pickard JD (2006) In vitro hydrodynamic properties of the Miethke ProGAV hydrocephalus shunt. Cerebrospinal Fluid Res 3:9. https:\/\/doi.org\/10.1186\/1743-8454-3-9","journal-title":"Cerebrospinal Fluid Res"},{"key":"4462_CR2","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1007\/s00701-014-2250-2","volume":"157","author":"M Andresen","year":"2015","unstructured":"Andresen M, Hadi A, Petersen LG, Juhler M (2015) Effect of postural changes on ICP in healthy and ill subjects. Acta Neurochir 157:109\u2013113. https:\/\/doi.org\/10.1007\/s00701-014-2250-2","journal-title":"Acta Neurochir"},{"key":"4462_CR3","doi-asserted-by":"publisher","unstructured":"Andresen M, Juhler M (2014) Intracranial pressure following complete removal of a small demarcated brain tumor: a model for normal intracranial pressure in humans. J Neurosurg:121. https:\/\/doi.org\/10.3171\/2014.2.JNS132209","DOI":"10.3171\/2014.2.JNS132209"},{"key":"4462_CR4","doi-asserted-by":"publisher","first-page":"e642","DOI":"10.1016\/j.wneu.2017.10.044","volume":"109","author":"S Antes","year":"2018","unstructured":"Antes S, Stadie A, Muller S, Linsler S, Breuskin D, Oertel J (2018) Intracranial pressure-guided shunt valve adjustments with the Miethke sensor reservoir. World Neurosurg 109:e642\u2013e650. https:\/\/doi.org\/10.1016\/j.wneu.2017.10.044","journal-title":"World Neurosurg"},{"key":"4462_CR5","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1227\/01.neu.0000137631.42164.b8","volume":"55","author":"M Bergsneider","year":"2004","unstructured":"Bergsneider M, Yang I, Hu X, McArthur DL, Cook SW, Boscardin WJ (2004) Relationship between valve opening pressure, body position, and intracranial pressure in normal pressure hydrocephalus: paradigm for selection of programmable valve pressure setting. Neurosurgery 55:851\u2013858; discussion 858-859. https:\/\/doi.org\/10.1227\/01.neu.0000137631.42164.b8","journal-title":"Neurosurgery"},{"key":"4462_CR6","doi-asserted-by":"publisher","first-page":"697","DOI":"10.3171\/2013.11.JNS121895","volume":"120","author":"A Chari","year":"2014","unstructured":"Chari A, Czosnyka M, Richards HK, Pickard JD, Czosnyka ZH (2014) Hydrocephalus shunt technology: 20 years of experience from the Cambridge shunt evaluation laboratory. J Neurosurg 120:697\u2013707. https:\/\/doi.org\/10.3171\/2013.11.JNS121895","journal-title":"J Neurosurg"},{"key":"4462_CR7","doi-asserted-by":"publisher","first-page":"1967","DOI":"10.1007\/s00701-017-3281-2","volume":"159","author":"A Chari","year":"2017","unstructured":"Chari A, Dasgupta D, Smedley A, Craven C, Dyson E, Matloob S, Thompson S, Thorne L, Toma AK, Watkins L (2017) Intraparenchymal intracranial pressure monitoring for hydrocephalus and cerebrospinal fluid disorders. Acta Neurochir 159:1967\u20131978. https:\/\/doi.org\/10.1007\/s00701-017-3281-2","journal-title":"Acta Neurochir"},{"key":"4462_CR8","doi-asserted-by":"publisher","first-page":"198","DOI":"10.3171\/2012.10.PEDS12239","volume":"11","author":"Z Czosnyka","year":"2013","unstructured":"Czosnyka Z, Pickard JD, Czosnyka M (2013) Hydrodynamic properties of the Certas hydrocephalus shunt. J Neurosurg Pediatr 11:198\u2013204. https:\/\/doi.org\/10.3171\/2012.10.PEDS12239","journal-title":"J Neurosurg Pediatr"},{"key":"4462_CR9","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.1007\/s00701-008-0138-8","volume":"150","author":"PK Eide","year":"2008","unstructured":"Eide PK, Sorteberg W (2008) Changes in intracranial pulse pressure amplitudes after shunt implantation and adjustment of shunt valve opening pressure in normal pressure hydrocephalus. Acta Neurochir 150:1141\u20131147; discussion 1147. https:\/\/doi.org\/10.1007\/s00701-008-0138-8","journal-title":"Acta Neurochir"},{"key":"4462_CR10","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/2045-8118-9-12","volume":"9","author":"A Eklund","year":"2012","unstructured":"Eklund A, Koskinen LO, Williams MA, Luciano MG, Dombrowski SM, Malm J (2012) Hydrodynamics of the Certas programmable valve for the treatment of hydrocephalus. Fluids Barriers CNS 9:12. https:\/\/doi.org\/10.1186\/2045-8118-9-12","journal-title":"Fluids Barriers CNS"},{"key":"4462_CR11","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1136\/jnnp-2014-308501","volume":"86","author":"D Farahmand","year":"2015","unstructured":"Farahmand D, Qvarlander S, Malm J, Wikkelso C, Eklund A, Tisell M (2015) Intracranial pressure in hydrocephalus: impact of shunt adjustments and body position. J Neurol Neurosurg Psychiatry 86:222\u2013228. https:\/\/doi.org\/10.1136\/jnnp-2014-308501","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"4462_CR12","doi-asserted-by":"publisher","first-page":"S38","DOI":"10.4103\/2152-7806.109197","volume":"4","author":"BR Lutz","year":"2013","unstructured":"Lutz BR, Venkataraman P, Browd SR (2013) New and improved ways to treat hydrocephalus: pursuit of a smart shunt. Surg Neurol Int 4:S38\u2013S50. https:\/\/doi.org\/10.4103\/2152-7806.109197","journal-title":"Surg Neurol Int"},{"key":"4462_CR13","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1097\/WCO.0000000000000651","volume":"32","author":"SP Mollan","year":"2019","unstructured":"Mollan SP, Hoffmann J, Sinclair AJ (2019) Advances in the understanding of headache in idiopathic intracranial hypertension. Curr Opin Neurol 32:92\u201398. https:\/\/doi.org\/10.1097\/WCO.0000000000000651","journal-title":"Curr Opin Neurol"},{"key":"4462_CR14","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1007\/s00701-016-3074-z","volume":"159","author":"SD Thompson","year":"2017","unstructured":"Thompson SD, Coutts A, Craven CL, Toma AK, Thorne LW, Watkins LD (2017) Elective ICP monitoring: how long is long enough? Acta Neurochir 159:485\u2013490. https:\/\/doi.org\/10.1007\/s00701-016-3074-z","journal-title":"Acta Neurochir"}],"container-title":["Acta Neurochirurgica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-020-04462-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00701-020-04462-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-020-04462-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T01:15:45Z","timestamp":1624497345000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00701-020-04462-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,24]]},"references-count":14,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2020,10]]}},"alternative-id":["4462"],"URL":"https:\/\/doi.org\/10.1007\/s00701-020-04462-y","relation":{},"ISSN":["0001-6268","0942-0940"],"issn-type":[{"value":"0001-6268","type":"print"},{"value":"0942-0940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,24]]},"assertion":[{"value":"16 March 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 June 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 June 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"No funding was received for the conduction of this study. LD\u2019s research fellowship is sponsored by B. Braun. MSM serves on the advisory board for Allergan, Novartis, Eli Lilly, Autonomic Technologies Inc. and TEVA and has received payment for the development of educational presentations from Allergan, electroCore, Eli Lilly, Novartis and TEVA. LDW has received honoraria from and served on advisory boards for Medtronic, B.Braun and Codman. AKT research time was supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. The other authors have no disclosures to report.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"All patients provided informed consent to undergo 24-h ICP monitoring as part of their clinical management.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}