Volume 12 Supplement 1

Abstracts from Hydrocephalus 2015

Open Access

External hydrocephalus in adults: an insidious cause of delayed intracranial hypertension. Report of 33 relevant cases treated with success by CSF lumbar drainage

  • Romain Manet1Email author,
  • Romain Guerin2,
  • Orianne Martinez3,
  • Gilles Francony2,
  • Jean-Paul Roustan3,
  • Jean-François Payen2,
  • Serge Molliex4,
  • Jêrome Morel4 and
  • Laurent Gergele4
Fluids and Barriers of the CNS201512(Suppl 1):P31

https://doi.org/10.1186/2045-8118-12-S1-P31

Published: 18 September 2015

Introduction

The concept of external hydrocephalus refers to situations of CSF flow impairment within subarachnoid spaces (SAS). Classically described in infant and children, literature offers few data on adult.

Material and methods

We retrospectively analysed adult patients admitted in four French intensive care units, between November 2010 and December 2014, for severe traumatic brain injury (TBI) or subarachnoid hemorrhage (SAH). We undertook clinical and radiological findings of patients presenting intracranial hypertension (ICHT) presumably in relation with external hydrocephalus (delayed ICHT concomitant to a paradoxical enlargement of subarachnoid spaces), treated with cerebrospinal fluid (CSF) external lumbar drainage (ELD).

Results

33 patients (19 men, mean age 46.7 yrs [+/-17.5]) admitted for TBI (n=22), SAH (n=8) or other brain insults (n=3) with a mean initial Glasgow score of 8 (+/- 4) were included. 25 (75.8%) patients did not receive former external ventricular drainage. In all cases, ELD was dramatically effective to lower intracranial pressure (25.2 mmHg [+/-9.1] before EDL vs 7.4 mmHg [+/-6.0] after EDL). No mydriasis or intracranial bleeding occurred. One patient (3%) developed an ELD infection. Patients were discharged from ICU with a mean modified Rankin Score of 4[+/-1].

Conclusions

Often described as a passive process (e.g. hygroma), CSF accumulation around the brain after acute cerebral insults in adults can be approached as an active process of external hydrocephalus. This diagnosis remains often subtle, but should systematically be evoked when CT scan show paradoxical enlargement of subarachnoid spaces in a context of ICHT. Our data tend to confirm that in these specific situations, ELD should be considered as a safe, effective and minimal invasive option.

Authors’ Affiliations

(1)
Department of Neurosurgery, University hospital of Saint-Etienne
(2)
Department of Intensive Care, University hospital of Grenoble
(3)
Department of Intensive Care, University hospital of Montpellier
(4)
Department of Intensive Care, University hospital of Saint-Etienne

Copyright

© Manet et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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