{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:30:28Z","timestamp":1769725828345,"version":"3.49.0"},"reference-count":70,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"19","license":[{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,11,10]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>CSF diversion with ventriculoperitoneal (VP) shunts is a common treatment for idiopathic intracranial hypertension (IIH). Rarely, overshunting can occur. Diagnosing and managing overshunting in an IIH patient with a shunt can be challenging. The authors present a unique etiology of overshunting successfully treated with shunt ligation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 48-year-old female with IIH who had undergone VP shunt placement with a programmable Certas valve presented with symptoms concerning for low-pressure headaches following a 25-kg weight loss. Intracranial pressure (ICP) monitoring along with an inpatient headache diary facilitated the diagnosis of intracranial hypotension secondary to CSF overdrainage through the shunt. Following shunt ligation, the patient experienced significant and durable symptom improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>In the setting of low-pressure headaches in an IIH patient with a functioning shunt, reductions in intra-abdominal pressure from weight loss can increase anterograde flow through the shunt. Additionally, the Certas programmable valve at its highest setting remains patent, but with a high opening pressure, potentially allowing for overdrainage due to the siphoning effect. Finally, ICP monitoring and headache diaries can significantly aid in the characterization of low-pressure headaches, and shunt ligation can be a curative solution.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25106\">https:\/\/thejns.org\/doi\/10.3171\/CASE25106<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25106","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:12:01Z","timestamp":1769685121000},"source":"Crossref","is-referenced-by-count":0,"title":["Weight loss and a shunt on \u201coff\u201d: an odd case of overshunting in an idiopathic intracranial hypertension patient. Illustrative case"],"prefix":"10.3171","volume":"10","author":[{"given":"Thomas","family":"Hamre","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley","family":"Ricciardelli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Flores","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashwin","family":"Viswanathan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"J Pain Res","first-page":"87","article-title":"Idiopathic intracranial hypertension: ongoing clinical challenges and future prospects","volume":"9","author":"Julayanont","year":"2016","unstructured":"Julayanont PKarukote ARuthirago DPanikkath DPanikkath R.Idiopathic intracranial hypertension: ongoing clinical challenges and future prospects. J Pain Res. 2016;9:87-99."},{"issue":"1","key":"bib2","series-title":"Br J Neurosurg","first-page":"62","article-title":"Ventriculo-peritoneal shunting is a safe and effective treatment for idiopathic intracranial hypertension","volume":"33","author":"Bjornson","year":"2019","unstructured":"Bjornson ATapply INabbanja EVentriculo-peritoneal shunting is a safe and effective treatment for idiopathic intracranial hypertension. Br J Neurosurg. 2019;33(1):62-70."},{"issue":"42","key":"bib3","series-title":"Medicine (Baltimore)","first-page":"e35545","article-title":"Should topiramate be initial therapy in the management of idiopathic intracranial hypertension? A literature review","volume":"102","author":"Goyal","year":"2023","unstructured":"Goyal AZarroli K.Should topiramate be initial therapy in the management of idiopathic intracranial hypertension? A literature review. Medicine (Baltimore). 2023;102(42):e35545."},{"issue":"3","key":"bib4","series-title":"Surg Neurol","first-page":"218","article-title":"The treatment of benign intracranial hypertension: a review of 134 cases","volume":"16","author":"Johnston","year":"1981","unstructured":"Johnston IPaterson ABesser M.The treatment of benign intracranial hypertension: a review of 134 cases. Surg Neurol. 1981;16(3):218-224."},{"issue":"8","key":"bib5","series-title":"Headache","first-page":"1303","article-title":"The idiopathic intracranial hypertension treatment trial: a review of the outcomes","volume":"57","author":"Smith","year":"2017","unstructured":"Smith SVFriedman DI.The idiopathic intracranial hypertension treatment trial: a review of the outcomes. 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JAMA Neurol. 2021;78(6):678-686."},{"issue":"2","key":"bib7","series-title":"J Neuroophthalmol","first-page":"224","article-title":"Complications of ventriculoperitoneal shunt for idiopathic intracranial hypertension: a single-institution study of 32 patients","volume":"41","author":"Brune","year":"2021","unstructured":"Brune AJGirgla TTrobe JD.Complications of ventriculoperitoneal shunt for idiopathic intracranial hypertension: a single-institution study of 32 patients. J Neuroophthalmol. 2021;41(2):224-232."},{"issue":"1","key":"bib8","series-title":"Stereotact Funct Neurosurg","first-page":"12","article-title":"Frameless stereotactic ventricular shunt placement for idiopathic intracranial hypertension","volume":"83","author":"Woodworth","year":"2005","unstructured":"Woodworth GFMcGirt MJElfert PSciubba DMRigamonti D.Frameless stereotactic ventricular shunt placement for idiopathic intracranial hypertension. Stereotact Funct Neurosurg. 2005;83(1):12-16."},{"issue":"7","key":"bib9","series-title":"Neurology","first-page":"1314","article-title":"Ventriculoperitoneal shunting for idiopathic intracranial hypertension","volume":"63","author":"Bynke","year":"2004","unstructured":"Bynke GZemack GBynke HRomner B.Ventriculoperitoneal shunting for idiopathic intracranial hypertension. Neurology. 2004;63(7):1314-1316."},{"issue":"6","key":"bib10","series-title":"Lancet Neurol","first-page":"655","article-title":"Headache arising from idiopathic changes in CSF pressure","volume":"14","author":"Ducros","year":"2015","unstructured":"Ducros ABiousse V.Headache arising from idiopathic changes in CSF pressure. 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Biomed J. 2022;45(1):95-108."},{"issue":"1","key":"bib28","series-title":"Surg Neurol","first-page":"14","article-title":"Valve inclination influences the performance of gravity-assisted valve","volume":"68","author":"Park","year":"2007","unstructured":"Park JKim GJHwang SK.Valve inclination influences the performance of gravity-assisted valve. Surg Neurol. 2007;68(1):14-18."},{"issue":"2","key":"bib29","series-title":"J Neurosurg Pediatr","first-page":"198","article-title":"Hydrodynamic properties of the Certas hydrocephalus shunt","volume":"11","author":"Czosnyka","year":"2013","unstructured":"Czosnyka ZPickard JDCzosnyka M.Hydrodynamic properties of the Certas hydrocephalus shunt. J Neurosurg Pediatr. 2013;11(2):198-204."},{"issue":"10","key":"bib30","series-title":"Acta Neurochir (Wien)","first-page":"2421","article-title":"In vitro performance of six combinations of adjustable differential pressure valves and fixed anti-siphon devices with and without vertical motion","volume":"162","author":"Fiss","year":"2020","unstructured":"Fiss IR\u00f6hrig PHore NIn vitro performance of six combinations of adjustable differential pressure valves and fixed anti-siphon devices with and without vertical motion. Acta Neurochir (Wien). 2020;162(10):2421-2430."},{"issue":"8","key":"bib31","series-title":"Acta Neurochir (Wien)","first-page":"1389","article-title":"Comparison of anti-siphon devices-how do they affect CSF dynamics in supine and upright posture?","volume":"159","author":"Gehlen","year":"2017","unstructured":"Gehlen MEklund AKurtcuoglu VMalm JSchmid Daners M.Comparison of anti-siphon devices-how do they affect CSF dynamics in supine and upright posture? Acta Neurochir (Wien). 2017;159(8):1389-1397."},{"issue":"8","key":"bib32","series-title":"Med Biol Eng Comput","first-page":"719","article-title":"Assessment of cerebrospinal fluid outflow resistance","volume":"45","author":"Eklund","year":"2007","unstructured":"Eklund ASmielewski PChambers IAssessment of cerebrospinal fluid outflow resistance. 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