• Adam Strand, Stephen Balise, Lawrence Jun Leung, and Susan Durham.
• Division of Neurosurgery, University of Vermont College of Medicine, Burlington, Vermont, USA.
• World Neurosurg. 2018 Jan 1; 109: e131-e135.

BackgroundThe entity of low-pressure hydrocephalus remains poorly understood and thoroughly debated. Symptomatic improvement accompanied by decrease in ventricular size after prolonged subatmospheric drainage has been well documented, and this method has been considered the criterion standard of management. Few studies have examined alternative treatment options, either to avoid the risks associated with prolonged external ventricular drainage or because of the failure of traditional methods.ObjectivesThis study compiled and examined reported cases of low-pressure hydrocephalus in an attempt to provide an up-to-date summary of the condition.MethodsA literature search was conducted by use of Ovid Medline and PubMed filtered for the past 25 years with specific key terms, inclusion criteria, and exclusion criteria. Selected case studies and case series were then compared, and statistical analysis was performed where appropriate.ResultsOver 25 years, 17 articles met our criteria. In addition to our case, 90 cases of LPH were reported. Magnetic resonance elastography (MRE) has proved to be an effective means of studying the viscoelastic properties of the brain. Endoscopic third ventriculostomy (ETV) appears to be a strong alternative, or additional, treatment.ConclusionMRE may prove to be effective in studying LPH because of its ability to quantify viscoelastic properties in response to therapy. Additionally, ETV should be considered in cases of LPH, although there is little evidence in the current literature to support its use. There are suggestions that it may lead to fewer shunt-dependent patients. Future studies are needed because there are few documented examples.Copyright © 2017 Elsevier Inc. All rights reserved.

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