The diagnosis and management for secondary low or negative-pressure hydrocephalus and a new hydrocephalus classification based on ventricle pressure.

The diagnosis and management for secondary low or negative-pressure hydrocephalus and a new hydrocephalus classification based on ventricle pressure.

World Neurosurg. 2019 Jan 03;:

Authors: Wu X, Zang D, Wu X, Sun Y, Yu J, Hu J

Abstract
BACKGROUND: Low-pressure hydrocephalus (LPH) and negative-pressure hydrocephalus (NegPH), secondary to traumatic brain injury, cerebral hemorrhage, tumor resection and central nervous system (CNS) infection in adults, are seldom reported and not enough recognized pathophysiologically in previous clinical practice, used to have poor prognosis. Routine shunt surgery had unsatisfactory outcomes. Current classifications of hydrocephalus cannot provide proper guidance to clinical practice, especially for LPH and NegPH.
METHODS: 39 cases of LPH and NegPH were included from Jan. 2013 to March 2018. Clinical features and image characteristics were reviewed. The Glasgow Outcome Scale-Extended (GOS-E) within three months were followed up, and management strategies were discussed in detail.
RESULTS: Ventricle pressure was lower than 70 mmH20 in all these 39 patients, and lowest to -10 mmH20. About average 3.5 times of operations were accepted for every patient. 18 cases were suffered CNS infection. 8 patients were dead, and poor prognosis with average GOS-E 2.7 for all patients besides 2 patients lost to follow-up. For other 29 surviving patients, the time interval from onset to the last Ventriculoperitoneal (VP) shunt achieved was 31d to 3880d and average 376d.
CONCLUSION: LPH and NegPH used to have poor prognosis. But a good prognosis can be achieved by proper management with further understanding the pathophysiology. Meanwhile, a new classification for hydrocephalus was proposed according to ventricle pressure, which is necessary and reasonable.

PMID: 30611954 [PubMed - as supplied by publisher]

from A via a.sfakia on Inoreader http://bit.ly/2LW3GQR