Treatment of low-pressure hydrocephalus using a novel shunt valve technique: applying Bernoulli's equation to fluid...

Low-pressure hydrocephalus (LPH) is the presence of persistent ventriculomegaly with low to normal intracranial pressure. Patients with LPH respond to subzero drainage, which consists of external ventricular drainage at levels below the external auditory meatus. Multiple treatment modalities have been described in the literature, but due to low intracranial pressures, weaning the external ventricular drain can take weeks to even months. This poses a relevant gap in the knowledge of treatment for LPH. The authors describe a new technique of placing a programmable differential pressure valve below the clavicle as an effective and feasible way to treat LPH. The authors present their experience with 3 patients with LPH who required prolonged subzero drainage and had a shunt valve placed below the clavicle as an effective treatment for LPH. Three patients were diagnosed with LPH and underwent subzero drainage, and drain weaning trials were unsuccessful. All 3 patients received a programmable valve below the clavicle that enabled an expedited discharge with return to baseline. A shunt valve placed caudal to the clavicle is a feasible and effective long-term treatment option for LPH.