{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T22:58:32Z","timestamp":1788562712379,"version":"build-2803163510"},"reference-count":62,"publisher":"IMR Press","issue":"3","license":[{"start":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T00:00:00Z","timestamp":1650240000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Integr. Neurosci."],"abstract":"<jats:p>The current management strategy of hydrocephalus mainly involves the insertion of a ventriculoperitoneal shunt and is inherently related with a complication widely known as shunt over-drainage. Albeit this is a well-recognized complication, the true incidence and severity of this phenomenon remains undefined and most probably underdiagnosed, necessitating a more comprehensive pathophysiologic and therapeutic consideration. The slit ventricle syndrome is intimately related with the entity of shunt over-drainage, although who\u2019s the definition of the former is implicated by a lack of universally accepted inclusion criteria. Another point of controversy is related with the absence of widely accepted criteria that would be able to discriminate the existing differentiations between these two entities. This is reflected in the fact that there are many proposed, relevant, treatment protocols. The background for all this data is based on the uncertainty and ambiguity regarding the pathophysiological mechanisms that are implicated. Current efforts are centered on the implementation of precautionary measures, as well as on treatment of both of these entities. Currently, there are enough evidence that support the concept that prevention of siphoning via the use of gravitational valves or antisiphon devices is the most efficacious means contained in our current therapeutic armamentarium. We attempt to present an overview of this complex entity, emphasizing on the hydrodynamics of the cerebrospinal fluid circulation in conditions harboring a ventriculoperitoneal shunt, the effect of the siphoning effect and the role of programmable valves and anti-siphon devices in our effort to eliminate this phenomenon. Based on an extensive literature review and on expert opinion, we concluded that the insertion of an anti-siphon device (gravitational shunt valves) could reliably address the issue of over-drainage, when a patient assumes a vertical position. Besides that, there are ongoing prospective studies centered on the safety and efficacy of adjustable gravitational valves, whose results are of ultimate importance. It is of paramount importance to be recognized that, due to the complexity of the pathophysiology of shunted hydrocephalus, lifelong follow-up of patients with ventriculoperitoneal shunts is necessary.<\/jats:p>","DOI":"10.31083\/j.jin2103084","type":"journal-article","created":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T07:21:09Z","timestamp":1650612069000},"source":"Crossref","is-referenced-by-count":19,"title":["Shunt Over-drainage, Slit Ventricle Syndrome, Programmable Valves and Anti-Siphon Devices. A Narrative Review of a Multifactorial and Intractable Problem"],"prefix":"10.31083","volume":"21","author":[{"given":"Dimitrios","family":"Panagopoulos","sequence":"first","affiliation":[{"name":"Neurosurgical Department of Pediatric Hospital of Athens, \u2018Agia Sophia\u2019, 11527 Athens, Attica, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Stranjalis","sequence":"first","affiliation":[{"name":"Medical School, University of Athens, First University Neurosurgical Department, \u2018Evangelismos\u2019 Hospital, 10676 Athens, Attica, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maro","family":"Gavra","sequence":"first","affiliation":[{"name":"Radiology Department of Pediatric Hospital of Athens, \u2018Agia Sophia\u2019, 11527 Athens, Attica, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efstathios","family":"Boviatsis","sequence":"first","affiliation":[{"name":"Medical School, University of Athens, Second University Neurosurgical Department, \u2018Attikon\u2019 Hospital, 12462 Athens, Attica, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanos","family":"Korfias","sequence":"first","affiliation":[{"name":"Medical School, University of Athens, First University Neurosurgical Department, \u2018Evangelismos\u2019 Hospital, 10676 Athens, Attica, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2022,4,18]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Tey ML, Ng LP, Low DCY, Seow WT, Low SYY. 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Neurosurgery. 1999; 44: 513\u2013519.","DOI":"10.1097\/00006123-199903000-00045"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Obana WG, Raskin NH, Cogen PH, Szymanski JA, Edwards MSB. Antimigraine Treatment for Slit Ventricle Syndrome. Neurosurgery. 1990; 27: 760\u2013763.","DOI":"10.1227\/00006123-199011000-00014"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Linder M, Diehl J, Sklar FH. Subtemporal decompressions for shunt-dependent ventricles: mechanism of action. Surgical Neurology. 1983; 19: 520\u2013523.","DOI":"10.1016\/0090-3019(83)90375-0"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Ros B, Iglesias S, Mart\u00edn A, Carrasco A, Ib\u00e1\u00f1ez G, Arr\u00e1ez MA. Shunt overdrainage syndrome: review of the literature. Neurosurgical Review. 2018; 41: 969\u2013981.","DOI":"10.1007\/s10143-017-0849-5"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Rekate HL. Shunt-related headaches: the slit ventricle syndromes. 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Monitoring and interpretation of intracranial pressure. Journal of Neurology, Neurosurgery, and Psychiatry. 2004; 75: 813\u2013821.","DOI":"10.1136\/jnnp.2003.033126"},{"key":"ref37","doi-asserted-by":"crossref","unstructured":"Boatwright A, Hughes S, Barry J. The height limit of a siphon. Scientific Reports. 2015; 5: 16790.","DOI":"10.1038\/srep16790"},{"key":"ref38","doi-asserted-by":"crossref","unstructured":"Di Rocco C. Is the slit ventricle syndrome always a slit ventricle syndrome? Child\u2019s Nervous System. 1994; 10: 49\u201358.","DOI":"10.1007\/BF00313585"},{"key":"ref39","doi-asserted-by":"crossref","unstructured":"Tschan CA, Antes S, Huthmann A, Vulcu S, Oertel J, Wagner W. Overcoming CSF overdrainage with the adjustable gravitational valve proSA. Acta Neurochirurgica. 2014; 156: 767\u2013776.","DOI":"10.1007\/s00701-013-1934-3"},{"key":"ref40","doi-asserted-by":"crossref","unstructured":"Koueik J, Kraemer MR, Hsu D, Rizk E, Zea R, Haldeman C, et al. 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In Reply: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Treatment of Pediatric Hydrocephalus: Update of the 2014 Guidelines. Neurosurgery. 2021; 89: E76\u2013E77.","DOI":"10.1093\/neuros\/nyab098"},{"key":"ref49","doi-asserted-by":"crossref","unstructured":"Kushnirsky M, Feun LG, Gultekin SH, de la Fuente MI. Prolonged Complete Response with Combined Dabrafenib and Trametinib after BRAF Inhibitor Failure in BRAF-Mutant Glioblastoma. JCO Precision Oncology. 2020; 4: 44\u201350.","DOI":"10.1200\/PO.19.00272"},{"key":"ref50","doi-asserted-by":"crossref","unstructured":"Zemack G, Bellner J, Siesj\u00f6 P, Str\u00f6mblad L, Romner B. Clinical experience with the use of a shunt with an adjustable valve in children with hydrocephalus. 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