648 S.-C. Hwang, T.-H. Kim, B.-T. Kim, et al. A A B C Fig. 1. Preoperative CT and X-ray. Ventriculomegaly with a bifrontal index of 41% and effacement of the cortical sulci is seen. The tempo- ral horn of the lateral ventricles is enlarged markedly (A, B). The shunt catheter is well placed in the right lateral ventricle. The abdominal catheter is located in the upper quadrant of the abdomen (C) and the urinary system is filled with contrast material. B C Fig. 2. CT and X-ray on postoperative day 1. The ventriculomegaly and dilation of the temporal horn have returned to normal (A, B). The catheter in the abdomen is shorter than preoperatively (C). puted tomography (CT, Fig. 1). The shunt catheter was placed properly in her head and abdomen (Fig. 1). When the flush- ing device was pumped, it was hard to pump. Ten milliters of CSF was aspirated from the flushing device. The aspirat- ed CSF was clear and no laboratory evidence of infection was observed. After aspirating the CSF, her consciousness improved remarkably, and she became alert. Malfunction of the catheter distal to the flushing device was strongly suspected. After preparing the skin with alcohol and povidone/iodine solution, a skin incision was made at the previous operative scar in the abdomen. The shunt catheter was placed in the peritoneal cavity and pulled out. The catheter was patent exter- nally, but no CSF was observed dripping from the catheter hole. No CSF flow was observed on pumping the flushing device. When 10 cm was cut from the end of the catheter, CSF dripped steadily from the catheter. The cutoff catheter had been occluded by a blood clot when it was irrigated. The remaining catheter was repositioned in the peritoneal cavi- ty. Her consciousness recovered fully immediately after the operation and her ventricle size returned to normal (Fig. 2). DISCUSSION With the development of shunt devices and the increasing success in treating hydrocephalus, more women with CSF shunts are surviving to child-bearing age. Abdominal com- plications are common with VP shunts (8, 9) and these may increase with the abdominal changes during pregnancy. As a result, a broad range of interdisciplinary health care profes- sionals in neurosurgery and obstetrics will require informa- tion about the management of these patients, especially dur- ing pregnancy and delivery (1). Interdisciplinary management of pregnant woman with CSF shunts should be performed dur- ing the preconception, antepartum, and postpartum periods. The early preconception management includes an evalua- tion of medication, especially anticonvulsants, which may be associated with increased risks to fetal development, and