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  • Title: Gravitational valves in supine patients with ventriculo-peritoneal shunts.
    Author: Deininger MH, Weyerbrock A.
    Journal: Acta Neurochir (Wien); 2009 Jun; 151(6):705-9; discussion 709. PubMed ID: 19337679.
    Abstract:
    BACKGROUND: In the subgroup of bedridden hydrocephalic patients with ventriculo-peritoneal shunts and gravitational valves, we occasionally observed persisting hydrocephalic complaints even when mechanical or infection-related obstruction was excluded. METHODS: To investigate the cause of these hydrocephalic symptoms, in vitro and in vivo analyses were used to determine valve opening, intra-abdominal and hydrostatic pressure of an Aesculap-Miethke 10/40 cm H2O gravitational valve at different angles of upper body and head inclination. FINDINGS: Since hydrostatic pressure is lacking, the resulting intra-ventricular pressures are shown to peak up to 27 cm H2O in supine patients with head, but not upper body inclined. CONCLUSIONS: We conclude that in the subgroup of bedridden patients with ventriculo-peritoneal shunts and gravitational valves, upright posture is a prerequisite for proper cerebrospinal fluid drainage.
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