Skip to main content

Advertisement

SpringerLink
Log in

Low-pressure CSF shunt malfunction without preceding lumbar puncture treated by epidural blood patch: report of 2 cases

  • Technical Notes
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Low-pressure CSF shunt malfunction is a poorly understood complication of hydrocephalus affecting patients of all ages. Treatment commonly requires external drainage of CSF to subatmospheric pressures for days to weeks in an intensive care setting. The current communication describes the repurposing of an established therapeutic technique, epidural blood patch, for successful initial management in 2 cases of low-pressure shunt malfunction in the absence of a recognized spinal CSF fistula. This technique may shorten length of stay and obviate potential morbidity in the management of what is otherwise a vexatious clinical problem.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Data availability

Not applicable

References

  1. Dias MS, Li V, Pollina J (1999) Low-pressure shunt “malfunction” following lumbar puncture in children with shunted obstructive hydrocephalus. Pediatr Neurosurg 30:146–150. https://doi.org/10.1159/000028783

  2. Foster KA, Deibert CP, Choi PA, Gardner PA, Tyler-Kabara EC, Engh JA (2016) Endoscopic third ventriculostomy as adjunctive therapy in the treatment of low-pressure hydrocephalus in adults. Surg Neurol Int 7:26. https://doi.org/10.4103/2152-7806.178522

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ghaleb A (2010) Postdural puncture headache. Anesthesiol Res Pract 2010. https://doi.org/10.1155/2010/102967

  4. Keough MB, Isaacs AM, Urbaneja G, Dronyk J, Lapointe AP, Hamilton MG (2020) Acute low-pressure hydrocephalus: a case series and systematic review of 195 patients. J Neurosurg:1-9. https://doi.org/10.3171/2020.4.JNS20476

  5. Pang D, Altschuler E (1994) Low-pressure hydrocephalic state and viscoelastic alterations in the brain. Neurosurgery 35:643–655. https://doi.org/10.1227/00006123-199410000-00010

    Article  CAS  PubMed  Google Scholar 

  6. Rekate HL (2009) Acute ventriculoperitoneal shunt malfunction following opening of the spinal subarachnoid space. Childs Nerv Syst 25:1395–1396. https://doi.org/10.1007/s00381-009-0946-z

    Article  PubMed  Google Scholar 

  7. Rekate HL (2019) Low or Negative Pressure Hydrocephalus Demystified. World Neurosurg 128:287–288. https://doi.org/10.1016/j.wneu.2019.05.032

    Article  PubMed  Google Scholar 

  8. Rekate HL, Nadkarni TD, Wallace D (2008) The importance of the cortical subarachnoid space in understanding hydrocephalus. J Neurosurg Pediatr 2:1–11. https://doi.org/10.3171/PED/2008/2/7/001

    Article  PubMed  Google Scholar 

  9. Smalley ZS, Venable GT, Einhaus S, Klimo P Jr (2017) Low-pressure Hydrocephalus in Children: A Case Series and Review of the Literature. Neurosurgery 80:439–447. https://doi.org/10.1093/neuros/nyw046

    Article  PubMed  Google Scholar 

  10. Vassilyadi M, Farmer JP, Montes JL (1995) Negative-pressure hydrocephalus. J Neurosurg 83:486–490. https://doi.org/10.3171/jns.1995.83.3.0486

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Adeline Kim

    Present address: Department of Anesthesiology, Loma Linda University Medical Center, Redlands, CA, USA

Authors and Affiliations

  1. Department of Anesthesia, Nemours / A I duPont Hospital for Children, Wilmington, DE, USA

    Adeline Kim & Doyle Lim

  2. Departments of Anesthesia, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    Adeline Kim & Doyle Lim

  3. Division of Neurosurgery, Nemours / A I duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA

    Joseph Piatt

  4. Departments of Neurological Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    Joseph Piatt

  5. Departments of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    Joseph Piatt

Authors
  1. Adeline Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Doyle Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joseph Piatt
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Dr Kim -collection of data, writing, and critical review of manuscript. Dr Lim -administrative support and critical review of manuscript. Dr Piatt -conception, collection of data, writing, and critical review of manuscript.

Corresponding author

Correspondence to Joseph Piatt.

Ethics declarations

Conflicts of interest

None

Ethics approval

The Nemours Delaware Valley IRB does not require review of reports of 2 or fewer cases and does not require patient or parent consent for case reports without identifying data.

Code availability

Not applicable

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, A., Lim, D. & Piatt, J. Low-pressure CSF shunt malfunction without preceding lumbar puncture treated by epidural blood patch: report of 2 cases. Childs Nerv Syst 37, 973–976 (2021). https://doi.org/10.1007/s00381-020-04996-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-020-04996-7

Keywords

Search

Navigation