====== Low-pressure hydrocephalus ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1bI4sPzH9iMxTqgiPT1h2RH5FZQGtvB9rwozOixoBG3pL2nkxh/?limit=15&utm_campaign=pubmed-2&fc=20250214040225}}
----

----

Low- or very-low-pressure [[hydrocephalus]] is a serious and rare phenomenon, which is becoming better known since it was first described in [[1994]] by Pang and Altschuler. Forced [[drainage]] at negative pressures can, in most cases, restore the [[ventricle]]s to their original size, thus achieving neurological [[recovery]]. 

Godoy Hurtado et al. from the Department of Neurosurgery, [[Jaén]] present six new cases that suffered this [[syndrome]] from [[2015]] to [[2020]]: two of them after [[medulloblastoma surgery]]; a third one as a consequence of a [[severe traumatic brain injury]] that required [[bifrontal]] [[craniectomy]]; another one after [[craniopharyngioma surgery]]; a fifth one with leptomeningeal [[glioneuronal tumor]]; and, finally, a patient carrier a shunt for [[normal pressure hydrocephalus]] diagnosed ten years before. At the moment of development of this condition, four of them had mid-low-pressure [[cerebrospinal fluid shunt]]s. Four patients required cerebrospinal fluid (CSF) drainage at negative pressures oscillating from zero to -15 mmHg by external ventricular drainage until ventricular size normalized, followed by the placement of a new definitive low-pressure shunt, one of them to the right [[atrium]]. 
The duration of drainage in negative pressures through [[external ventricular drainage]] (EVD) ranged from 10 to 40 days with concomitant [[intracranial pressure monitoring]] at the [[neurointensive care unit]]. Approximately 200 cases of this syndrome have been described in the literature. The causes are varied and superimposable to those of high-pressure hydrocephalus. Neurological impairment is due to [[ventricular size]] and not to pressure values. Subzero drainage is still the most commonly used method, but other treatments have been described, such as neck wrapping, [[ventriculostomy]] of the [[third ventricle]], and lumbar [[blood patch]]es when associated with [[lumbar puncture]]. Its [[pathophysiology]] is not clear, although it seems to involve changes in the [[permeability]] and [[viscoelasticity]] of the [[brain parenchyma]] together with an [[imbalance]] in [[cerebrospinal fluid circulation]] in the craniospinal [[subarachnoid space]]
((Godoy Hurtado A, Barstchi P, Brea Salvago JF, Al-Ghanem R, Galicia Bulnes JM, El Rubaidi O. Low- and Negative-Pressure Hydrocephalus: New Report of Six Cases and Literature Review. J Clin Med. 2023 Jun 18;12(12):4112. doi: 10.3390/jcm12124112. Erratum in: J Clin Med. 2025 Feb 02;14(3):959. doi: 10.3390/jcm14030959. PMID: 37373809; PMCID: PMC10299038.)). 
----
Godoy Hurtado et al. present an informative case series that contributes to the growing awareness and understanding of LoVLPH. Their emphasis on forced CSF drainage as a primary treatment aligns with current practices, but further clarity is needed on the pathophysiology, long-term outcomes, and standardized diagnostic approaches. Future research should focus on larger cohort studies with extended follow-up to better delineate prognosis and refine treatment protocols. Despite its limitations, this study serves as a valuable addition to the literature and highlights the need for continued investigation into this rare but clinically significant condition.