Measurements of intraventricular pressure in a patient shunted from the ventricle to the internal jugular vein against the direction of blood flow (the El-Shafei shunt)

Object: After demonstrating the anti-siphoning properties of a distensible tube in vitro, El-Shafei constructed a shunting system that directs CSF flo w into the internal jugular vein against the flow of blood. Though clinical ly effective, the in vivo pressure dynamics of this type of shunt system ha ve not been investigated. Methods: After failure at multiple other extracra nial absorptive sites, an 18-year-old woman was shunted from the lateral ve ntricle to the internal jugular vein against the direction of blood flow. T he shunt system contained an in-line noninvasive telemonitor allowing exami nation of postural intracranial pressure dynamics in the awake state. This shunt system demonstrated postural pressure dynamics that were consistent w ith a stringent nonsiphoning shunting system. Conclusions: These observatio ns validate the use of the El-Shafei shunt placement as a biologically nons iphoning CSF absorptive system. In addition, the stringency of the anti-sip honing properties of the internal jugular vein open the possibility of pref erentially using this shunting system in patients who clearly exhibit sympt oms of shunt overdrainage.