Letter regarding the endovascular transdural cerebrospinal fluid shunt device

We read the article by Heilman et al 1 with great interest. Their idea is very clever and has the potential to solve the problems inherent in ventriculoperitoneal shunt device application. However, we would like to highlight some issues with their study from the viewpoint of the anatomy of the petroclival region. The aim of the device was described as “diverting excess CSF from the intracranial subarachnoid space to the adjacent cerebral venous system through an endovascular transdural shunt device”.1 The anatomical architecture of the subarachnoid and subdural spaces in the retroclival area differs from the calvarial region.2 3 The arachnoid membrane lying over the clivus was reported as being the “anterior pontine membrane”,4 which was clearly documented in the literature.2 …