{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T22:20:11Z","timestamp":1761862811271},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1986,8]]},"abstract":"<jats:p content-type=\"fine-print\">\u2713 Eighteen hydrocephalic children who presented with subtle deterioration when their shunts malfunctioned were studied during shunt revision by means of the pressure-volume index (PVI) technique. Bolus manipulation of cerebrospinal fluid (CSF) was used to determine the PVI and the resistance to the absorption of CSF (R<jats:sub>o<\/jats:sub>). Ventricular size was moderately to severely enlarged in all the children. Steady-state intracranial pressure (ICP) at the time of shunt revision was 17.5 \u00b1 7.3 mm Hg (range 8 to 35 mm Hg). Pressure waves could not be induced by bolus injections in the 8- to 35-mm Hg range of ICP tested. The mean \u00b1 standard deviation (SD) of the predicted normal PVI for this group was 18.5 \u00b1 2.7 ml. The mean \u00b1 standard error of the mean of the measured PVI was 35.5 \u00b1 2.1 ml, which represented a 187% \u00b1 33% (\u00b1 SD) increase in volume-buffering capacity (p &lt; 0.001). The ICP did not fall after bolus injections in three children, so that the R<jats:sub>o<\/jats:sub> could not be measured. In the remaining 15 patients, R<jats:sub>o<\/jats:sub> increased linearly as a function of ICP (r = 0.74, p &lt; 0.001). At ICP's below 20 mm Hg, R<jats:sub>o<\/jats:sub> ranged from 2.0 to 5.0 mm Hg\/ml\/min, but increased to as high as 21 mm Hg\/ml\/min when ICP was above 20 mm Hg.<\/jats:p>\n<jats:p content-type=\"fine-print\">This study documents that subtle deterioration in shunted hydrocephalic children is accompanied by abnormally compliant pressure-volume curves. These children develop ventricular enlargement and neurological deterioration without acute episodic pressure waves. The biomechanical profile of this group differs from other children with CSF shunts.<\/jats:p>","DOI":"10.3171\/jns.1986.65.2.0211","type":"journal-article","created":{"date-parts":[[2009,5,8]],"date-time":"2009-05-08T16:22:26Z","timestamp":1241799746000},"page":"211-216","source":"Crossref","is-referenced-by-count":20,"title":["Subtle deterioration in shunted childhood hydrocephalus"],"prefix":"10.3171","volume":"65","author":[{"given":"Arno","family":"Fried","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth","family":"Shapiro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Anesthesiology","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1097\/00000542-198102000-00001","article-title":"Isoflurane and cerebrospinal fluid pressure in neurosurgical patients.","volume":"54","author":"Adams","year":"1981"},{"key":"b2","series-title":"Intracranial Pressure IV.","first-page":"492","article-title":"Intracranial pressure changes in \u201carrested\u201d hydrocephalus","author":"Blesser","year":"1980"},{"key":"b3","series-title":"Brain","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1093\/brain\/91.4.707","article-title":"Formation and absorption of cerebrospinal fluid in man.","volume":"91","author":"Cutler","year":"1968"},{"key":"b4","series-title":"Childs Brain","first-page":"359","article-title":"The study of cerebrospinal fluid dynamics in apparently \u201carrested\u201d hydrocephalus in children.","volume":"3","author":"Di Rocco","year":"1977"},{"key":"b5","series-title":"Hydrocephalus.","first-page":"315","article-title":"Increased intracranial pressure in hydrocephalic children with functioning shunts: a complication of shunt dependency","author":"Epstein","year":"1984"},{"key":"b6","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"29","DOI":"10.3171\/jns.1974.41.1.0029","article-title":"Subtemporal craniectomy for recurrent shunt obstruction secondary to small ventricles.","volume":"41","author":"Epstein","year":"1974"},{"key":"b7","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.3171\/jns.1963.20.12.1064","article-title":"Five-year comparative study of hydrocephalus in children with and without operation (113 cases).","volume":"20","author":"Foltz","year":"1963"},{"key":"b8","series-title":"Dev Med Child Neurol","first-page":"55","article-title":"Normal pressure hydrocephalus in patients with myelomeningocele.","volume":"18","author":"Hammock","year":"1976"},{"key":"b9","series-title":"Monogr Neural Sci","first-page":"227","article-title":"Can a shunt be removed?","volume":"8","author":"Hemmer","year":"1982"},{"key":"b10","series-title":"Dev Med Child Neurol","first-page":"69","article-title":"Once a shunt, always a shunt?","volume":"18","author":"Hemmer","year":"1976"},{"key":"b11","series-title":"Childs Brain","first-page":"137","article-title":"Subtemporal decompression for the slit-ventricle syndrome after shunting in hydrocephalic children.","volume":"5","author":"Holness","year":"1979"},{"key":"b12","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"698","DOI":"10.3171\/jns.1973.39.6.0698","article-title":"Shunt-independent arrest of hydrocephalus.","volume":"39","author":"Holtzer","year":"1973"},{"key":"b13","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1212\/WNL.20.7.665","article-title":"A simple constant-infusion manometric test for measurement of CSF absorption. 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