Temporary Control of Cerebrospinal Fluid Volume and Pressure by Means of an Externalized Valve-Drainage System

Abstract

T RADITIONALLY, the development of acute, sustained increases in ventricular pressure and volume resulting from cerebrospinal fluid (CSF) obstruction has been managed by repeated direct ventricular puncture 4 or the establishment of a tube ventriculostomy. 2 The method of repetitive direct needle puncture of the leaves much to be desired since it is not only damaging to brain tissue, but is basically unphysiological because it can only discontinuously affect ventricular volume and pressure. Tube ventriculostomy does offer the advantage of continuous drainage, but does not provide satisfactory hydraulic control. Its major drawback, however, is the constant danger of retrograde infection of the brain which severely limits the length of time it can be left in place. To circumvent some of the disadvantages of these techniques in the temporary management of acute increased ventricular pressure-volume states, we have used a simplified system of continuous pressure-modulated ventricular drainage utilizing standard Spitz-Holter shunt equipment. 1~ This report describes our clinical experience with this technique of CSF shunting which we have termed the externalized 5th ventricle drainage system.