{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T01:04:08Z","timestamp":1780448648330,"version":"3.54.1"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"22","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"\n BACKGROUND<\/jats:title>\n Negative-pressure hydrocephalus is a rare form of symptomatic ventriculomegaly characterized by subatmospheric intracranial pressure (ICP). It can occur following lumbar puncture (LP) in patients with impaired CSF dynamics and is frequently mistaken for ventriculoperitoneal (VP) shunt malfunction.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors describe the case of a 9-year-old boy with prior medulloblastoma and a VP shunt who presented with neurological decline following LP. Symptoms transiently improved following a large-volume shunt tap, but ventriculomegaly persisted despite shunt revision. ICP monitoring confirmed negative pressure, consistent with post-LP negative-pressure hydrocephalus. Management with an epidural blood patch, neck wrapping, and shunt valve adjustment resulted in clinical and radiographic improvement, notably without the need for prolonged subatmospheric external ventricular drainage.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Negative-pressure hydrocephalus should be suspected in patients with a shunt who present with ventriculomegaly, a plausible CSF leak, low-pressure CSF, and poor response to shunt revision. The presence of fourth ventricular obstruction should further heighten suspicion. Effective management involves recognizing altered CSF pressure gradients that mimic high-pressure hydrocephalus, considering epidural blood patch placement to repair CSF leakage, using neck wrapping to augment venous pressure and raise intraventricular pressure to the valve\u2019s opening threshold, and avoiding unnecessary shunt revisions or repeat LPs in susceptible patients.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE2654<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case2654","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:55Z","timestamp":1779840055000},"source":"Crossref","is-referenced-by-count":0,"title":["Lumbar puncture\u2013induced negative-pressure hydrocephalus in a child with a ventriculoperitoneal shunt and ventricular obstruction: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0806-0994","authenticated-orcid":true,"given":"Bryn L.","family":"Hoffman","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, University of Toronto, Ontario;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun Suresh","family":"Chandran","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Laughlin","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Hospital for Sick Children, Toronto, Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George M.","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"bib1","series-title":"Neurosurgery","first-page":"643","article-title":"Low-pressure hydrocephalic state and viscoelastic alterations in the brain","volume":"35","author":"Pang","year":"1994","unstructured":"Pang DAltschuler E.Low-pressure hydrocephalic state and viscoelastic alterations in the brain. Neurosurgery. 1994;35(4):643-655. doi:10.1227\/00006123-199410000-00010"},{"issue":"5","key":"bib2","series-title":"J Neurosurg","first-page":"1031","article-title":"Negative-pressure and low-pressure hydrocephalus: the role of cerebrospinal fluid leaks resulting from surgical approaches to the cranial base","volume":"115","author":"Filippidis","year":"2011","unstructured":"Filippidis ASKalani MYSNakaji PRekate HL.Negative-pressure and low-pressure hydrocephalus: the role of cerebrospinal fluid leaks resulting from surgical approaches to the cranial base. J Neurosurg. 2011;115(5):1031-1037. doi:10.3171\/2011.6.JNS101504"},{"issue":"3","key":"bib3","series-title":"Neurosurgery","first-page":"439","article-title":"Low-pressure hydrocephalus in children: a case series and review of the literature","volume":"80","author":"Smalley","year":"2017","unstructured":"Smalley ZSVenable GTEinhaus SKlimo P.Low-pressure hydrocephalus in children: a case series and review of the literature. Neurosurgery. 2017;80(3):439-447. doi:10.1093\/neuros\/nyw046"},{"key":"bib4","series-title":"World Neurosurg","first-page":"56","article-title":"Low-pressure hydrocephalus and shunt malfunction following a lumbar puncture in an adult reversed by an epidural blood patch","volume":"143","author":"Vilela","year":"2020","unstructured":"Vilela MDPedrosa HAMesquita BFHoriguchi CLF.Low-pressure hydrocephalus and shunt malfunction following a lumbar puncture in an adult reversed by an epidural blood patch. World Neurosurg. 2020;143:56-61. doi:10.1016\/j.wneu.2020.07.134"},{"issue":"12","key":"bib5","series-title":"J Clin Med","first-page":"4112","article-title":"Low- and negative-pressure hydrocephalus: new report of six cases and literature review","volume":"12","author":"Godoy Hurtado","year":"2023","unstructured":"Godoy Hurtado ABarstchi PBrea Salvago JFAl-Ghanem RGalicia Bulnes JMEl Rubaidi O.Low- and negative-pressure hydrocephalus: new report of six cases and literature review. 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J Neurosurg Pediatr. 2008;2(1):1-11. doi:10.3171\/PED\/2008\/2\/7\/001"},{"issue":"10","key":"bib11","series-title":"Childs Nerv Syst","first-page":"1535","article-title":"A consensus on the classification of hydrocephalus: its utility in the assessment of abnormalities of cerebrospinal fluid dynamics","volume":"27","author":"Rekate","year":"2011","unstructured":"Rekate HL.A consensus on the classification of hydrocephalus: its utility in the assessment of abnormalities of cerebrospinal fluid dynamics. 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