Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
J Neurosurg. 2011 Nov;115(5):1031-7. doi: 10.3171/2011.6.JNS101504. Epub 2011 Jul 29.
Negative-pressure and low-pressure hydrocephalus are rare clinical entities that are frequently misdiagnosed. They are characterized by recurrent episodes of shunt failure because the intracranial pressure is lower than the opening pressure of the valve. In this report the authors discuss iatrogenic CSF leaks as a cause of low- or negative-pressure hydrocephalus after approaches to the cranial base.
The authors retrospectively reviewed cases of low-pressure or negative-pressure hydrocephalus presenting after cranial approaches complicated with a CSF leak at their institution.
Three patients were identified. Symptoms of high intracranial pressure and ventriculomegaly were present, although the measured pressures were low or negative. A blocked communication between the ventricles and the subarachnoid space was documented in 2 of the cases and presumed in the third. Shunt revisions failed repeatedly. In all cases, temporary clinical and radiographic improvement resulted from external ventricular drainage at subatmospheric pressures. The CSF leaks were sealed and CSF communication was reestablished operatively. In 1 case, neck wrapping was used with temporary success.
Negative-pressure or low-pressure hydrocephalus associated with CSF leaks, especially after cranial base approaches, is difficult to treat. The solution often requires the utilization of subatmospheric external ventricular drains to establish a lower ventricular drainage pressure than the drainage pressure created in the subarachnoid space, where the pressure is artificially lowered by the CSF leak. Treatment involves correction of the CSF leak, neck wrapping to increase brain turgor and allow the pressure in the ventricles to rise to the level of the opening pressure of the valve, and reestablishing the CSF route.
负压和低颅压性脑积水是罕见的临床病症，常被误诊。它们的特征是反复出现分流失败，因为颅内压低于阀门的开启压力。在本报告中，作者讨论了颅底入路后因脑脊髓液（CSF）漏导致低颅压或负颅压性脑积水的医源性原因。
作者回顾性分析了在他们机构就诊的因 CSF 漏而并发颅底入路后出现低颅压或负颅压性脑积水的病例。
确定了 3 例患者。尽管测量的压力较低或为负值，但存在高颅内压和脑室扩大的症状。在 2 例病例中记录到脑室和蛛网膜下腔之间的通讯受阻，在第 3 例病例中推测存在通讯受阻。分流器多次重新调整失败。在所有病例中，通过在亚大气压下进行外部脑室引流，暂时获得了临床和影像学改善。CSF 漏得到了封堵，CSF 通讯通过手术重新建立。在 1 例病例中，使用颈围暂时获得成功。
与 CSF 漏相关的负压或低压性脑积水，尤其是颅底入路后，治疗困难。解决方案通常需要利用亚大气压外部脑室引流来建立低于蛛网膜下腔引流压力的脑室引流压力，CSF 漏会人为地降低蛛网膜下腔的压力。治疗包括纠正 CSF 漏、颈围包扎以增加脑肿胀，使脑室压力升高至阀门开启压力水平，并重新建立 CSF 通路。
