[Continuous CSF aspiration. An alternative in the management of acute hydrocephalus]

As proposed by Marmarou in 1976, in case of acute hydrocephalus high intracranial pressure (I.C.P.) can be controlled by withdrawing the ventricular cerebrospinal fluid (C.S.F.) at a constant rate equal to the rate of C.S.F. formation. We experienced this procedure since 1989 in 17 patients presenting with acute hydrocephalus consecutive to aneurysmal subarachnoid hemorrhage (11 cases) or infratentorial mass (6 cases). A ventricular catheter was connected to an electrical syringe of which the motor driving direction has been inverted. Using an outflow rate ranging from 0.15 to 0.20 ml/mn, i.e. lower than the physiological C.S.F. rate formation, this controlled continuous mechanical ventricular C.S.F. drainage has serious advantages compared to a traditional external ventricular C.S.F. drainage. These advantages are mainly the better control of intracranial pressure (fiability of I.C.P. monitoring, lowered risk of hyperdrainage), more comfort for the patient and the nursing staff and lower cost.