Negative-pressure hydrocephalus in the course of a complex postoperative intracranial pressure disturbance: illustrative case

Abstract

BACKGROUNDNegative-pressure hydrocephalus (NePH) is a rare clinical entity that presents on the background of ventriculomegaly with atypical symptoms. Its diagnosis is difficult, and some patients experience several shunt revisions until the proper solution is found.OBSERVATIONSThe authors present a patient who developed acute deterioration due to iatrogenic NePH after surgery for a vertebral artery thrombosed giant aneurysm. The deterioration occurred after the insertion of a lumbar drain by which the authors intended to reduce a postoperative subcutaneous cerebrospinal fluid (CSF) collection. The drainage created an unexpected negative-pressure gradient in the CSF spaces, which resulted in NePH. Interventions, such as extraventricular drainage and blood patch, corrected the negative transmantle pressure and stabilized the patient’s condition.LESSONSBecause the pathophysiology of NePH is theoretically considered to be caused by negative transmantle pressure, the intervention should be performed in order to deal with the coexistence of obstruction in the CSF pathways and a CSF leak. A blood patch would be an effective option in treating the CSF leak when the site of leakage is certain. This is the first case in which a blood patch was effectively applied in the treatment for NePH with a favorable outcome without any permanent CSF diversion.

Low-/Negative-Pressure Hydrocephalus: To Understand the Formation Mechanism from the Perspective of Clinicians

“…The blood patch blocked the CSF leak and corrected the persistently falling SAS pressure, eventually leading to improvement in the patient's symptoms. 18 CSF leakage and blocked CSF circulation may also result in LPH alone. [19][20][21] One patient developed low intracranial pressure and enlarged ventricles after vertebral artery dissection.…”

“…The blood patch blocked the CSF leak and corrected the persistently falling SAS pressure, eventually leading to improvement in the patient's symptoms. 18…”