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How to define CSF overdrainage: a systematic literature review

  • Review Article - Neurosurgery General
  • Published:
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Abstract

Purpose

Overdrainage (OD) is one of the most frequent complications related to drainage of the cerebrospinal fluid (CSF). It is mostly associated with valve-bearing shunt systems but should probably be considered as a risk factor in any type of CSF diversion procedure. There is extreme variation in the reported incidence of OD due to the lack of consensus on defining criteria and an unclear perception of the pathophysiology. Hence, OD is probably underreported and underestimated. The objective of this paper was to establish a definition of OD, based on a systematic review of the literature.

Methods

A systematic search was conducted in MEDLNE and EMBASE. Studies providing a definition or a description of diagnostic findings related to OD in ventriculoperitoneal shunt treated hydrocephalus were included. Non-English titles, abstracts and manuscripts were excluded. Extracted descriptions were graded into five groups (class I-V studies) based on how precise the terminology used to describe OD was. Class I studies were included for further analysis and characteristics of OD were extracted. The quality of included descriptions was assessed by a clinical expert panel.

Results

A total of 1309 studies were screened, 190 were graded into groups, and 22, which provided specific definitions or descriptions of OD, were graded as class I studies. We extracted 32 different characteristics consistent with OD (e.g., clinical symptoms, radiological signs, and syndromes).

Conclusion

There was an overall agreement that CSF overdrainage following implantation of a ventriculoperitoneal shunt in a mixed pediatric and adult population is characterized as a persistent condition with clinically manifestations as postural dependent headache, nausea, and vomiting and/or radiological signs of slim ventricles and/or subdural collections.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark

    Sarah Hornshoej Pedersen & Marianne Juhler

  2. Centre for Orthopaedic Research and Innovation, Slagelse Hospital, Slagelse, Denmark

    Tobias Hannibal Prein

  3. Department of Neurosurgery, King Fahd University Hospital, Al Khobar, Saudi Arabia

    Ahmed Ammar

  4. Medical Centre, Radboud University, Nijmegen, The Netherlands

    André Grotenhuis

  5. Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Calgary, Canada

    Mark G. Hamilton

  6. Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark

    Torben Skovbo Hansen & Marianne Juhler

  7. Department of Neurosurgery, Asklepios Klinik Altona, Hamburg, Germany

    Uwe Kehler

  8. The Donald and Barbara Zucker Hofstra Northwell School of Medicine, Hempstead, New York, USA

    Harold Rekate

  9. Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany

    Ulrich-Wilhelm Thomale

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  1. Sarah Hornshoej Pedersen
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Correspondence to Sarah Hornshoej Pedersen.

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Pedersen, S.H., Prein, T.H., Ammar, A. et al. How to define CSF overdrainage: a systematic literature review. Acta Neurochir 165, 429–441 (2023). https://doi.org/10.1007/s00701-022-05469-3

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