US counterpoint to chapter 15

In Chapter 15, Rustamzadeh and Lam provided a thorough discussion of cerebrospinal fluid (CSF) shunting and have proposed rational recommendations for long-term care and follow-up of shunted patients. Many, if not most, patients do not conform well to a standardized schedule of care. Table 1 shows our current practice for routine care. Several factors may modify the management of individual patients. CSF diversion is indicated for a variety of diagnoses, and numerous surgical techniques and hardware choices exist. In addition, patients often become more complex with each shunt revision. These variables preclude entirely uniform recommendations for long-term care and follow-up. Beyond routine care, a number of situations require particular attention. Suspected shunt malfunction or infection prompts the majority of unscheduled office or emergency room visits and have been thoroughly reviewed. Pregnancy in shunted patients warrants further discussion. Although much of the care of shunted patients involves addressing issues that arise unexpectedly, routine follow-up plays an important role in minimizing morbidity in these patients.