{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T09:11:29Z","timestamp":1779527489603,"version":"3.53.1"},"reference-count":70,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2016,9]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Reservoirs integrated into hydrocephalus shunts are commonly used for the removal of CSF and for intra-ventricular pressure measurement. Pumping with the reservoir to diagnose shunt sufficiency is still a matter of controversy. The authors describe an improved flushing device and its characteristic features in vitro and in vivo.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The flushing reservoir is constructed with a sapphire ball in a cage as a nonresistance valve to also enable the detection of distal occlusions. The most important reservoir parameters were investigated in vitro, simulating total and partial proximal and distal shunt occlusions. Then the expected advantages were assessed in vivo by evaluating the pump test data of 360 implanted reservoirs. The results were compared with those found in the literature.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n The optimization of the technical parameters of the device, such as the high stroke volume in combination with moderate suction force, are obvious advantages compared with other flushing devices. Total occlusion of the ventricular catheter and the valve could be assessed with high certainty. The detection of a total obstruction of the peritoneal catheter or any partial obstruction is also possible, depending on its exact grade and location.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Shunt obstructions can be assessed using the pumping test. The reservoir construction presented here provides a clear enhancement of that diagnostic test.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2016.6.focus15540","type":"journal-article","created":{"date-parts":[[2016,9,1]],"date-time":"2016-09-01T03:39:30Z","timestamp":1472701170000},"page":"E14","source":"Crossref","is-referenced-by-count":7,"title":["An improved reservoir for the flushing test to diagnose shunt insufficiency"],"prefix":"10.3171","volume":"41","author":[{"given":"Hans-Georg","family":"Schlosser","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Universit\u00e4tsmedizin Berlin - Charit\u00e9, Berlin;"},{"name":"Gutachten Neurochirurgie, Wirbels\u00e4ule, und Physiologie (NWP), Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Joachim","family":"Crawack","sequence":"additional","affiliation":[{"name":"Christoph Miethke GmbH, Potsdam; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Miethke","sequence":"additional","affiliation":[{"name":"Christoph Miethke GmbH, Potsdam; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thoralf","family":"Knitter","sequence":"additional","affiliation":[{"name":"Christoph Miethke GmbH, Potsdam; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Zeiner","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Universit\u00e4tsmedizin Berlin - Charit\u00e9, Berlin;"},{"name":"Gutachten Neurochirurgie, Wirbels\u00e4ule, und Physiologie (NWP), Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Sprung","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Universit\u00e4tsmedizin Berlin - Charit\u00e9, Berlin;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus15540","series-title":"In-vitro-Testung von Hydrocephalus-Ventilen [dissertation]","first-page":"179","author":"Aschoff","year":"1994"},{"key":"b2-focus15540","series-title":"An in vitro study, in 54th Annual Meeting of the German Society of Neurosurgery.","article-title":"The reliability of palpatoric shunt checks","author":"Aschoff","year":"2003"},{"key":"b3-focus15540","series-title":"In-vitro-studies for the reliability, limitations and side-effects of palpatoric shunt checks, in Proceedings of the 14th Congress of the European Society for Pediatric Neurosurgery.","article-title":"Shunt function control by valve pumping - fact or fancy?","author":"Aschoff","year":"1994"},{"key":"b4-focus15540","series-title":"J Am Coll Surg","first-page":"79","article-title":"John Holter's shunt","volume":"192","author":"Baru","year":"2001"},{"key":"b5-focus15540","series-title":"Acta Neurochir (Wien)","first-page":"544","article-title":"The puncturable ventriculo-atrial shunt for hydrocephalus. A preliminary report","volume":"13","author":"Bondurant","year":"1965"},{"key":"b6-focus15540","series-title":"Cerebrospinal Fluid Res","first-page":"2","article-title":"Laboratory study on \u201cintracranial hypotension\u201d created by pumping the chamber of a hydrocephalus shunt","volume":"4","author":"Bromby","year":"2007"},{"key":"b7-focus15540","series-title":"J Neurosurg","first-page":"697","article-title":"Hydrocephalus shunt technology: 20 years of experience from the Cambridge Shunt Evaluation Laboratory","volume":"120","author":"Chari","year":"2014"},{"key":"b8-focus15540","series-title":"J Neurosurg","first-page":"85","article-title":"Twin reservoir flushing device for hydrocephalus. Technical note","volume":"28","author":"Coe","year":"1968"},{"key":"b9-focus15540","series-title":"Acta Neurochir Suppl","first-page":"27","article-title":"Shunt testing in-vivo: a method based on the data from the UK shunt evaluation laboratory","volume":"81","author":"Czosnyka","year":"2002"},{"key":"b10-focus15540","series-title":"Pediatr Neurosurg","first-page":"76","article-title":"Editorial comment","volume":"25","author":"Drake","year":"1996"},{"key":"b11-focus15540","series-title":"Childs Nerv Syst","first-page":"302","article-title":"A nonlinear biomechanical model for evaluation of cerebrospinal fluid shunt systems","volume":"10","author":"Hafez","year":"1994"},{"key":"b12-focus15540","series-title":"Kaohsiung J Med Sci","first-page":"29","article-title":"Cerebellar hemorrhage after multiple manual pumping tests of a ventriculoperitoneal shunt: a case report","volume":"25","author":"Huang","year":"2009"},{"key":"b13-focus15540","series-title":"Pediatr Neurosurg","first-page":"77","article-title":"Editorial comment","volume":"25","author":"Humphreys","year":"1996"},{"key":"b14-focus15540","series-title":"Childs Nerv Syst","first-page":"449","article-title":"Ventriculoperitoneal shunts for hydrocephalus: a focus group discussion on the selection of shunt systems in pediatrics. A report of the Pediatric Neurosurgery Research Group meeting, December 1992","volume":"11","author":"James","year":"1995"},{"key":"b15-focus15540","series-title":"Eur J Pediatr Surg","first-page":"25","article-title":"The significance of continuous CSF measurement in suspected shunt dysfunction","volume":"39","author":"Kaiser","year":"1984"},{"key":"b16-focus15540","series-title":"Surgery of Cervical Myelopathy","first-page":"222","article-title":"Complications following shunt operations in children","volume":"8","author":"Liesegang","year":"1980"},{"key":"b17-focus15540","series-title":"Neurosurgery","first-page":"198","article-title":"Evaluation of the ShuntCheck noninvasive thermal technique for shunt flow detection in hydrocephalic patients","volume":"68","author":"Madsen","year":"2011"},{"key":"b18-focus15540","series-title":"Invest Radiol","first-page":"555","article-title":"Evaluation of cerebrospinal fluid flow through a Pudenz 12 mm or a standard Rickham reservoir: phantom experiments","volume":"12","author":"Maeda","year":"1977"},{"key":"b19-focus15540","series-title":"Br J Neurosurg","first-page":"321","article-title":"Mechanical complications of the reservoirs and flushing devices in ventricular shunt systems","volume":"6","author":"Martinez-Lage","year":"1992"},{"key":"b20-focus15540","series-title":"Surg Forum","first-page":"399","article-title":"Treatment of hydrocephalus by direct shunt from ventricle to jugular vain","volume":"1951","author":"Nulsen","year":"1951"},{"key":"b21-focus15540","series-title":"Lancet","first-page":"983","article-title":"Subcutaneous reservoir and pump for sterile access to ventricular cerebrospinal fluid","volume":"2","author":"Ommaya","year":"1963"},{"key":"b22-focus15540","series-title":"Childs Brain","first-page":"25","article-title":"Correlation of the response of the flushing device to compression with the clinical picture in the evaluation of the functional status of the shunting system","volume":"3","author":"Osaka","year":"1977"},{"key":"b23-focus15540","series-title":"Pediatr Emerg Care","first-page":"827","article-title":"Additive value of nuclear medicine shuntograms to computed tomography for suspected cerebrospinal fluid shunt obstruction in the pediatric emergency department","volume":"25","author":"Ouellette","year":"2009"},{"key":"b24-focus15540","series-title":"Acta Neurol Scand","first-page":"317","article-title":"In vivo assessment of hydrocephalus shunt","volume":"120","author":"Petrella","year":"2009"},{"key":"b25-focus15540","series-title":"Pediatrics","first-page":"470","article-title":"Physical examination of patients with cerebrospinal fluid shunts: is there useful information in pumping the shunt?","volume":"89","author":"Piatt","year":"1992"},{"key":"b26-focus15540","series-title":"Pediatr Neurosurg","first-page":"73","article-title":"Pumping the shunt revisited. A longitudinal study","volume":"25","author":"Piatt","year":"1996"},{"issue":"Suppl 1","key":"b27-focus15540","series-title":"J Neurol Neurosurg Psychiatry","first-page":"i17","article-title":"Hydrocephalus and shunts: what the neurologist should know","volume":"73","author":"Pople","year":"2002"},{"key":"b28-focus15540","series-title":"Pediatric Neurosurgery, Theoretic Principles, Art of Surgical Techniques","first-page":"453","article-title":"Hydrocephalus","author":"Raimondi","year":"1998"},{"key":"b29-focus15540","series-title":"BMJ","first-page":"173","article-title":"A ventriculostomy reservoir","volume":"2","author":"Rickham","year":"1964"},{"key":"b30-focus15540","series-title":"West J Med","first-page":"93","article-title":"Cerebrospinal fluid shunts","volume":"127","author":"Sells","year":"1977"},{"key":"b31-focus15540","series-title":"Pediatr Radiol","first-page":"1029","article-title":"Neuroimaging of ventriculoperitoneal shunt complications in children","volume":"42","author":"Sivaganesan","year":"2012"},{"key":"b32-focus15540","series-title":"Pediatr Neurosurg","first-page":"180","article-title":"Evaluation of shunt malfunction using shunt site reservoir","volume":"32","author":"Sood","year":"2000"},{"key":"b33-focus15540","series-title":"Childs Nerv Syst","first-page":"157","article-title":"Useful components of the shunt tap test for evaluation of shunt malfunction","volume":"9","author":"Sood","year":"1993"},{"key":"b34-focus15540","series-title":"Acta Neurochir (Wien)","first-page":"767","article-title":"Overcoming CSF overdrainage with the adjustable gravitational valve proSA","volume":"156","author":"Tschan","year":"2014"},{"key":"b35-focus15540","series-title":"Childs Nerv Syst","first-page":"43","article-title":"Radioisotope shuntograms at the Children's Hospital of Eastern Ontario","volume":"22","author":"Vassilyadi","year":"2006"},{"key":"b1-focus15540","series-title":"In-vitro-Testung von Hydrocephalus-Ventilen [dissertation]","first-page":"179","author":"Aschoff","year":"1994"},{"key":"b2-focus15540","series-title":"An in vitro study, in 54th Annual Meeting of the German Society of Neurosurgery.","article-title":"The reliability of palpatoric shunt checks","author":"Aschoff","year":"2003"},{"key":"b3-focus15540","series-title":"In-vitro-studies for the reliability, limitations and side-effects of palpatoric shunt checks, in Proceedings of the 14th Congress of the European Society for Pediatric Neurosurgery.","article-title":"Shunt function control by valve pumping - fact or fancy?","author":"Aschoff","year":"1994"},{"key":"b4-focus15540","series-title":"J Am Coll Surg","first-page":"79","article-title":"John Holter's shunt","volume":"192","author":"Baru","year":"2001"},{"key":"b5-focus15540","series-title":"Acta Neurochir (Wien)","first-page":"544","article-title":"The puncturable ventriculo-atrial shunt for hydrocephalus. A preliminary report","volume":"13","author":"Bondurant","year":"1965"},{"key":"b6-focus15540","series-title":"Cerebrospinal Fluid Res","first-page":"2","article-title":"Laboratory study on \u201cintracranial hypotension\u201d created by pumping the chamber of a hydrocephalus shunt","volume":"4","author":"Bromby","year":"2007"},{"key":"b7-focus15540","series-title":"J Neurosurg","first-page":"697","article-title":"Hydrocephalus shunt technology: 20 years of experience from the Cambridge Shunt Evaluation Laboratory","volume":"120","author":"Chari","year":"2014"},{"key":"b8-focus15540","series-title":"J Neurosurg","first-page":"85","article-title":"Twin reservoir flushing device for hydrocephalus. Technical note","volume":"28","author":"Coe","year":"1968"},{"key":"b9-focus15540","series-title":"Acta Neurochir Suppl","first-page":"27","article-title":"Shunt testing in-vivo: a method based on the data from the UK shunt evaluation laboratory","volume":"81","author":"Czosnyka","year":"2002"},{"key":"b10-focus15540","series-title":"Pediatr Neurosurg","first-page":"76","article-title":"Editorial comment","volume":"25","author":"Drake","year":"1996"},{"key":"b11-focus15540","series-title":"Childs Nerv Syst","first-page":"302","article-title":"A nonlinear biomechanical model for evaluation of cerebrospinal fluid shunt systems","volume":"10","author":"Hafez","year":"1994"},{"key":"b12-focus15540","series-title":"Kaohsiung J Med Sci","first-page":"29","article-title":"Cerebellar hemorrhage after multiple manual pumping tests of a ventriculoperitoneal shunt: a case report","volume":"25","author":"Huang","year":"2009"},{"key":"b13-focus15540","series-title":"Pediatr Neurosurg","first-page":"77","article-title":"Editorial comment","volume":"25","author":"Humphreys","year":"1996"},{"key":"b14-focus15540","series-title":"Childs Nerv Syst","first-page":"449","article-title":"Ventriculoperitoneal shunts for hydrocephalus: a focus group discussion on the selection of shunt systems in pediatrics. A report of the Pediatric Neurosurgery Research Group meeting, December 1992","volume":"11","author":"James","year":"1995"},{"key":"b15-focus15540","series-title":"Eur J Pediatr Surg","first-page":"25","article-title":"The significance of continuous CSF measurement in suspected shunt dysfunction","volume":"39","author":"Kaiser","year":"1984"},{"key":"b16-focus15540","series-title":"Surgery of Cervical Myelopathy","first-page":"222","article-title":"Complications following shunt operations in children","volume":"8","author":"Liesegang","year":"1980"},{"key":"b17-focus15540","series-title":"Neurosurgery","first-page":"198","article-title":"Evaluation of the ShuntCheck noninvasive thermal technique for shunt flow detection in hydrocephalic patients","volume":"68","author":"Madsen","year":"2011"},{"key":"b18-focus15540","series-title":"Invest Radiol","first-page":"555","article-title":"Evaluation of cerebrospinal fluid flow through a Pudenz 12 mm or a standard Rickham reservoir: phantom experiments","volume":"12","author":"Maeda","year":"1977"},{"key":"b19-focus15540","series-title":"Br J Neurosurg","first-page":"321","article-title":"Mechanical complications of the reservoirs and flushing devices in ventricular shunt systems","volume":"6","author":"Martinez-Lage","year":"1992"},{"key":"b20-focus15540","series-title":"Surg Forum","first-page":"399","article-title":"Treatment of hydrocephalus by direct shunt from ventricle to jugular vain","volume":"1951","author":"Nulsen","year":"1951"},{"key":"b21-focus15540","series-title":"Lancet","first-page":"983","article-title":"Subcutaneous reservoir and pump for sterile access to ventricular cerebrospinal fluid","volume":"2","author":"Ommaya","year":"1963"},{"key":"b22-focus15540","series-title":"Childs Brain","first-page":"25","article-title":"Correlation of the response of the flushing device to compression with the clinical picture in the evaluation of the functional status of the shunting system","volume":"3","author":"Osaka","year":"1977"},{"key":"b23-focus15540","series-title":"Pediatr Emerg Care","first-page":"827","article-title":"Additive value of nuclear medicine shuntograms to computed tomography for suspected cerebrospinal fluid shunt obstruction in the pediatric emergency department","volume":"25","author":"Ouellette","year":"2009"},{"key":"b24-focus15540","series-title":"Acta Neurol Scand","first-page":"317","article-title":"In vivo assessment of hydrocephalus shunt","volume":"120","author":"Petrella","year":"2009"},{"key":"b25-focus15540","series-title":"Pediatrics","first-page":"470","article-title":"Physical examination of patients with cerebrospinal fluid shunts: is there useful information in pumping the shunt?","volume":"89","author":"Piatt","year":"1992"},{"key":"b26-focus15540","series-title":"Pediatr Neurosurg","first-page":"73","article-title":"Pumping the shunt revisited. A longitudinal study","volume":"25","author":"Piatt","year":"1996"},{"issue":"Suppl 1","key":"b27-focus15540","series-title":"J Neurol Neurosurg Psychiatry","first-page":"i17","article-title":"Hydrocephalus and shunts: what the neurologist should know","volume":"73","author":"Pople","year":"2002"},{"key":"b28-focus15540","series-title":"Pediatric Neurosurgery, Theoretic Principles, Art of Surgical Techniques","first-page":"453","article-title":"Hydrocephalus","author":"Raimondi","year":"1998"},{"key":"b29-focus15540","series-title":"BMJ","first-page":"173","article-title":"A ventriculostomy reservoir","volume":"2","author":"Rickham","year":"1964"},{"key":"b30-focus15540","series-title":"West J Med","first-page":"93","article-title":"Cerebrospinal fluid shunts","volume":"127","author":"Sells","year":"1977"},{"key":"b31-focus15540","series-title":"Pediatr Radiol","first-page":"1029","article-title":"Neuroimaging of ventriculoperitoneal shunt complications in children","volume":"42","author":"Sivaganesan","year":"2012"},{"key":"b32-focus15540","series-title":"Pediatr Neurosurg","first-page":"180","article-title":"Evaluation of shunt malfunction using shunt site reservoir","volume":"32","author":"Sood","year":"2000"},{"key":"b33-focus15540","series-title":"Childs Nerv Syst","first-page":"157","article-title":"Useful components of the shunt tap test for evaluation of shunt malfunction","volume":"9","author":"Sood","year":"1993"},{"key":"b34-focus15540","series-title":"Acta Neurochir (Wien)","first-page":"767","article-title":"Overcoming CSF overdrainage with the adjustable gravitational valve proSA","volume":"156","author":"Tschan","year":"2014"},{"key":"b35-focus15540","series-title":"Childs Nerv Syst","first-page":"43","article-title":"Radioisotope shuntograms at the Children's Hospital of Eastern Ontario","volume":"22","author":"Vassilyadi","year":"2006"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/41\/3\/article-pE14.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/41\/3\/article-pE14.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/41\/3\/article-pE14.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T08:58:14Z","timestamp":1779526694000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/41\/3\/article-pE14.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,9]]},"references-count":70,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2016.6.focus15540","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,9]]}}}