Acta Neurochirurgica

, Volume 158, Issue 7, pp 1273–1278 | Cite as

Female gender predisposes for cerebrospinal fluid overdrainage in ventriculoperitoneal shunting

  • Naïma Diesner
  • Florian Freimann
  • Christin Clajus
  • Kai Kallenberg
  • Veit Rohde
  • Florian StockhammerEmail author
Clinical Article - Neurosurgical Techniques



Gravitational valves (GVs) prevent overdrainage in ventriculoperitoneal shunting (VPS). However, there are no data available on the appropriate opening pressure in the shunt system when implementing a GV. We performed a retrospective analysis of hydrocephalic patients who were successfully treated with VPS which included one or more GV.


In this retrospective study in adult VPS patients with GVs, we analysed all available data, including the most recent computed tomography (CT) scans, to determine the best adjustments for alleviating any symptoms of overdrainage and underdrainage. Vertical effective opening pressure (VEOP) of the entire shunt system, including the differential pressure valve, was determined.


One hundred and twenty-two patients were eligible for the study. Of these, female patients revealed a higher VEOP compared with males (mean, 35.6 cmH2O [SD ± 2.46] vs 28.9 cmH2O [SD ± 0.87], respectively, p = 0.0072, t-test). In patients older than 60 years, lower VEOPs, by a mean of 6.76 cmH2O ± 2.37 (p = 0.0051), were necessary. Mean VEOP was found to be high in idiopathic intracranial hypertension (IIH; 41.6 cmH2O) and malresorptive and congenital HC (35.9 and 36.3), but low in normal pressure HC (27.5, p = 0.0229; one-way ANOVA). In the total cohort, body mass index (BMI) and height did not correlate with VEOP. Twelve patients required a VEOP of more than 40 cmH2O, and in eight of these patients this was accomplished by using multiple GVs. All but one of these eight patients were of female gender, and none of the latter were treated for normal pressure hydrocephalus (NPH) (p = 0.0044 and p = 0.0032, Fisher’s exact test).


In adult VPS patients, female gender increases the risk of overdrainage requiring higher VEOPs. Initial implantation of adjustable GV should be considered in female patients treated with VP shunts for pathology other than NPH.


Ventriculoperitoneal shunt Hydrocephalus Overdrainage Gravitational valve 



We would like to thank to Bawarjan Schatlo for helpful comments for preparing the manuscript.

Compliance with ethical standards


No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. F.F., C.C., V.R. and F.S. received speaker fees from Braun-Äskulap/Miethke. C.C. received a price endowed by Braun-Äskulap/Miethke

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.


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Copyright information

© Springer-Verlag Wien 2016

Authors and Affiliations

  • Naïma Diesner
    • 1
  • Florian Freimann
    • 1
  • Christin Clajus
    • 1
    • 2
  • Kai Kallenberg
    • 3
  • Veit Rohde
    • 1
  • Florian Stockhammer
    • 1
    • 4
    Email author
  1. 1.Department of NeurosurgeryUniversity Medical Center GöttingenGöttingenGermany
  2. 2.Diagnostic and Interventional Radiology and NeuroradiologyHelios Hospital ErfurtErfurtGermany
  3. 3.Institute for Diagnostic and Interventional NeuroradiologyUniversity Medical Center GöttingenGöttingenGermany
  4. 4.Department of NeurosurgeryDresden-Friedrichstadt Municipal HospitalDresdenGermany

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