{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T21:38:06Z","timestamp":1757453886763},"reference-count":9,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>Maintenance of pressure gradient within the intracranial chamber, shunt hardware, and the abdominal cavity plays a significant role in the optimal functioning of the ventriculo peritoneal shunt. We report a rare and a complex scenario in a patient with normal pressure hydrocephalus (NPH) who had recurrent and refractory ventricular peritoneal shunt dysfunction. Following a meticulous analysis, this was attributed to a very rare, and, first to be documented in the literature, a combination of an evolved very low pressure hydrocephalus (VLPH) system and asymptomatic raised intra-abdominal pressure (IAP).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Case Description: <\/jats:title>\n<jats:p>A 72-year-old male presented with NPH syndrome, associated with recurrent shunt dysfunction. A thorough systematic evaluation, which included intracranial pressure monitoring and IAP monitoring, revealed the presence of VLPH and a concomitant elevated IAP that was asymptomatic. This unique situation required changes in surgical strategy, which included correction of VLPH state, insertion of the anti-siphon device, and the placement of the distal end of the shunt into the pleural cavity. This led to solving the \u201cmystery\u201d of recurrent shunt dysfunction in this complex scenario.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>It is imperative to perform the pressure analysis of the intracranial chamber, shunt hardware, and even the abdominal cavity, especially, in every case of refractory shunt revisions. Possibilities of a rare cause such as VLPH or an asymptomatic raised IAP acting alone or in combination must be considered. Only then, the final cerebrospinal fluid diversion strategy should be decided.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_586_2022","type":"journal-article","created":{"date-parts":[[2022,11,25]],"date-time":"2022-11-25T06:32:14Z","timestamp":1669357934000},"page":"546","update-policy":"http:\/\/dx.doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Solving a complex, rare, and challenging scenario in a normal pressure hydrocephalus with recurrent shunt dysfunction and multiple revisions \u2013 The opposing role of evolving low-pressure hydrocephalus and idiopathic raised intra-abdominal pressure"],"prefix":"10.25259","volume":"13","author":[{"given":"Anirudha Bharat","family":"Doshi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hrishikesh","family":"Sarkar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yashwant","family":"Shelke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amit","family":"Pothare","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amey","family":"Kulkarni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2022,11,25]]},"reference":[{"key":"10.25259\/SNI_586_2022\/ref-1","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.jss.2005.06.015","article-title":"Normal intraabdominal pressure in healthy adults","volume":"129","author":"Cobb","year":"2005","journal-title":"J Surg Res"},{"key":"10.25259\/SNI_586_2022\/ref-2","doi-asserted-by":"crossref","first-page":"24","DOI":"10.4103\/0028-3886.222820","article-title":"Cerebrospinal fluid shunts-how they work: The basics","volume":"66","author":"Chatterjee","year":"2018","journal-title":"Neurol India"},{"key":"10.25259\/SNI_586_2022\/ref-3","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1007\/s00134-009-1445-0","article-title":"What is normal intra-abdominal pressure on how is it affected by positioning, body mass and positive end-expiratory pressure?","volume":"35","author":"De Keulenaer","year":"2009","journal-title":"Intensive Care Med"},{"key":"10.25259\/SNI_586_2022\/ref-4","first-page":"187","article-title":"The physics of the cranial cavity, hydrocephalus and normal pressure hydrocephalus: Mechanical interpretation and mathematical model","volume":"5","author":"Hakim","year":"1976","journal-title":"Surg Neurol"},{"key":"10.25259\/SNI_586_2022\/ref-5","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1016\/S0140-6736(06)69811-5","article-title":"Coma due to meteorism and increased intra-abdominal pressure subsequent to ventriculoperitoneal shunt dysfunction","volume":"368","author":"Mirzayan","year":"2006","journal-title":"Lancet"},{"key":"10.25259\/SNI_586_2022\/ref-6","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1227\/00006123-199410000-00010","article-title":"Low-pressure hydrocephalic state and viscoelastic alterations in the brain","volume":"35","author":"Pang","year":"1994","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_586_2022\/ref-7","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.spen.2009.01.002","article-title":"A contemporary definition and classification of hydrocephalus","volume":"16","author":"Rekate","year":"2009","journal-title":"Semin Pediatr Neurol"},{"key":"10.25259\/SNI_586_2022\/ref-8","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1227\/01.NEU.0000311071.33615.E1","article-title":"Intra-abdominal pressure: The neglected variable in selecting the ventriculoperitoneal shunt for treating hydrocephalus","volume":"62","author":"Sahuquillo","year":"2008","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_586_2022\/ref-9","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1046\/j.1365-2796.1997.89104000.x","article-title":"Intra-abdominal pressure, sagittal abdominal diameter and obesity comorbidity","volume":"241","author":"Sugerman","year":"1997","journal-title":"J Intern Med"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/solving-a-complex-rare-and-challenging-scenario-in-a-normal-pressure-hydrocephalus-with-recurrent-shunt-dysfunction-and-multiple-revisions-the-opposing-role-of-evolving-low-pressure-hydroce\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/solving-a-complex-rare-and-challenging-scenario-in-a-normal-pressure-hydrocephalus-with-recurrent-shunt-dysfunction-and-multiple-revisions-the-opposing-role-of-evolving-low-pressure-hydroce\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,25]],"date-time":"2022-11-25T06:32:21Z","timestamp":1669357941000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/solving-a-complex-rare-and-challenging-scenario-in-a-normal-pressure-hydrocephalus-with-recurrent-shunt-dysfunction-and-multiple-revisions-the-opposing-role-of-evolving-low-pressure-hydroce\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,25]]},"references-count":9,"alternative-id":["10.25259\/SNI_586_2022"],"URL":"https:\/\/doi.org\/10.25259\/sni_586_2022","relation":{},"ISSN":["2152-7806"],"issn-type":[{"value":"2152-7806","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,25]]},"article-number":"546"}}