Foster Kimberly A, Deibert Christopher P, Choi Phillip A, Gardner Paul A, Tyler-Kabara Elizabeth C, Engh Johnathan A
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Surg Neurol Int. 2016 Mar 10;7:26. doi: 10.4103/2152-7806.178522. eCollection 2016.
Treatment of low-pressure hydrocephalus (LPH) may require prolonged external ventricular drainage (EVD) at sub-zero pressures to reverse ventriculomegaly. Endoscopic third ventriculostomy (ETV) has been used in the treatment of noncommunicating hydrocephalus; however, indications for ETV are expanding.
Patients with the diagnosis of LPH as defined by the Pang and Altschuler criteria who underwent sub-zero drainage treatment over an 8-year period were included. Patients were divided into two cohorts based on whether or not ETV was employed during their treatment. Time from EVD placement to internalization of shunt was recorded for both groups; time from ETV to placement of shunt was recorded for the patients undergoing ETV.
Sixteen adult patients with LPH were managed with sub-zero drainage method. Ten (62.5%) patients did not undergo ETV and the average time from first ventriculostomy to shunting was 73 days (range 14-257 days). Six (37.5%) patients underwent ETV during the course of their treatment; average time from initial ventriculostomy to shunt was 114 days (range 0-236 days) (P = 0.16). Time from development of LPH to ETV ranged from 28 days to 6.5 months. In the ETV group, of the 4 patients who underwent shunting, the average time to shunting following ETV was 15.25 days.
ETV can be used successfully in the management of refractory LPH to decrease the duration of EVD.
低压性脑积水（LPH）的治疗可能需要在低于零的压力下进行长时间的脑室外引流（EVD），以逆转脑室扩大。内镜下第三脑室造瘘术（ETV）已用于治疗非交通性脑积水；然而，ETV的适应证正在扩大。
纳入符合Pang和Altschuler标准定义的LPH诊断且在8年期间接受低于零压力引流治疗的患者。根据治疗期间是否采用ETV将患者分为两个队列。记录两组从EVD置管到分流管植入的时间；记录接受ETV治疗的患者从ETV到分流管植入的时间。
16例成年LPH患者采用低于零压力引流方法治疗。10例（62.5%）患者未接受ETV，从首次脑室造瘘到分流的平均时间为73天（范围14 - 257天）。6例（37.5%）患者在治疗过程中接受了ETV；从最初脑室造瘘到分流的平均时间为114天（范围0 - 236天）（P = 0.16）。从LPH发病到ETV的时间为28天至6.5个月。在ETV组中，4例接受分流的患者，ETV后平均分流时间为15.25天。
ETV可成功用于难治性LPH的治疗，以缩短EVD的持续时间。
