{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T04:06:25Z","timestamp":1792987585179,"version":"4.5.0"},"reference-count":25,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,6,18]],"date-time":"2023-06-18T00:00:00Z","timestamp":1687046400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["JCM"],"abstract":"<jats:p>Low- or very-low-pressure hydrocephalus is a serious and rare phenomenon, which is becoming better known since it was first described in 1994 by Pang and Altschuler. Forced drainage at negative pressures can, in most cases, restore the ventricles to their original size, thus achieving neurological recovery. We present six new cases that suffered this syndrome from 2015 to 2020: two of them after medulloblastoma surgery; a third one as a consequence of a severe head trauma that required bifrontal craniectomy; another one after craniopharyngioma surgery; a fifth one with leptomeningeal glioneuronal tumor; and, finally, a patient carrier a shunt for normotensive hydrocephalus diagnosed ten years before. At the moment of development of this condition, four of them had mid-low-pressure cerebrospinal fluid (CSF) shunts. Four patients required cerebrospinal fluid (CSF) drainage at negative pressures oscillating from zero to \u221215 mmHg by external ventricular drainage until ventricular size normalized, followed by the placement of a new definitive low-pressure shunt, one of them to the right atrium. The duration of drainage in negative pressures through external ventricular drainage (EVD) ranged from 10 to 40 days with concomitant intracranial pressure monitoring at the neurointensive care unit. Approximately 200 cases of this syndrome have been described in the literature. The causes are varied and superimposable to those of high-pressure hydrocephalus. Neurological impairment is due to ventricular size and not to pressure values. Subzero drainage is still the most commonly used method, but other treatments have been described, such as neck wrapping, ventriculostomy of the third ventricle, and lumbar blood patches when associated with lumbar puncture. Its pathophysiology is not clear, although it seems to involve changes in the permeability and viscoelasticity of the brain parenchyma together with an imbalance in CSF circulation in the craniospinal subarachnoid space.<\/jats:p>","DOI":"10.3390\/jcm12124112","type":"journal-article","created":{"date-parts":[[2023,6,19]],"date-time":"2023-06-19T02:29:19Z","timestamp":1687141759000},"page":"4112","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Low- and Negative-Pressure Hydrocephalus: New Report of Six Cases and Literature Review"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0579-4463","authenticated-orcid":false,"given":"Alicia","family":"Godoy Hurtado","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Ja\u00e9n Neurotrauma Hospital, 23001 Jaen, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Barstchi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ja\u00e9n Neurotrauma Hospital, 23001 Jaen, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Brea Salvago","sequence":"additional","affiliation":[{"name":"Department of Neurocritical Care, Ja\u00e9n Neurotrauma Hospital, 23001 Jaen, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajab","family":"Al-Ghanem","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ja\u00e9n Neurotrauma Hospital, 23001 Jaen, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Galicia Bulnes","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ja\u00e9n Neurotrauma Hospital, 23001 Jaen, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osamah","family":"El Rubaidi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ja\u00e9n Neurotrauma Hospital, 23001 Jaen, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/BF01402168","article-title":"A report of eight patients with low pressure hydrocephalus treated by C.S.F. diversion with disappointing results","volume":"27","author":"Bannister","year":"1972","journal-title":"Acta Neurochir."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1080\/02688690209168360","article-title":"Low pressure hydrocephalus and ventriculomegaly: Hysteresis, non-linear dynamics, and the benefits of CSF diversion","volume":"16","author":"Lesniak","year":"2002","journal-title":"Br. 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