Low Pressure Hydrocephalus after Shunt Revision: Postrevisional low pressure hydrocephalus
We report two cases of young patients presenting postrevisional low pressure hydrocephalus. The first case is a 18-year-old boy, who was installed VP shunt because of medulloblastoma two years ago. The ventricular system had changed to slit during the shunt-patent period. The shunt was revised, using a medium pressure one, due to obstructive problem of the ventricular side. However, conscious disturbance and ventricular dilatation did not improved. Shuntgraphy and manometric study showed that the system was patent, and the measured intraventricular pressure via flushing device was very low. Further change to a low pressure system was also not effective. CSF drainage through the flushing device, setting at the under-level from the ventricle, was dramatically effective. After the continuous CSF removal for four days, the patient’s condition and the ventricular size had been recovered. The second case is a 10-year-old girl with medulloblastoma, very similar to the first case. In this case, deteriorated neurological condition which was not getting better after the revision, had been improved via CSF drainage setting at the under-level from the ventricle. Finally, the drainage was able to be changed to the low pressure shunt system.