In Reply: Low-Pressure Hydrocephalus in Children: A Case Series and Review of the Literature

摘要

Copyright © 2017 by the Congress of Neurological SurgeonsTo the Editor:We thank Dr Barami for his insightful letter.1 We have read with interest the referenced literature regarding the role of the cerebral venous system in governing intracranial pressure and the theory of cerebral venous overdrainage (CVO).2,3 The concept of cerebrospinal fluid (CSF) and cerebral venous compartment coupling and its regulation by the Starling resistor was of particular interest to us as we did not include it in our publication.4 This model offers yet another explanation for the development of low-pressure hydrocephalus (LPH) following lumbar puncture (LP).5,6 Dr Birani states that CSF diversion causes CSF hypotension in the subarachnoid space, leading to the loss of the Starling effect on draining cortical veins. This loss of venous outflow regulation, magnified by the upright position, allows for unregulated siphoning of cortical venous blood...