title: Low-pressure hydrocephalus: indication for custom-made catheters? Technical report.
abstract: BACKGROUND
  Low-pressure hydrocephalus (LPH) is characterized by ventriculomegaly with persistent low intracranial pressure (ICP). Sub-zero drainage is needed for its management and multiple solutions have been described. Our aim is to report our experience with custom-made peritoneal catheters with larger inner diameter as an alternative treatment option.
  
  
  METHODS
  We made a retrospective review of all patients diagnosed with LPH and treated with custom-made peritoneal catheters at the Virgen del Rocío Pediatric Neurosurgical Unit. Catheters were coated with antibiotic or silver. The inner diameter of ventricular catheters was 1.4 mm; peritoneal catheters were larger than usual (1.9 mm inner diameter).
  
  
  RESULTS
  We identified four patients in whom five custom-made peritoneal catheters were used over a 3-year period. There were two males and the mean age was 10 years (6 months-17 years). In all patients, placement of an EVD was necessary for sub-zero drainage, with maximum negative pressure of -8 cm H20. The mean time of maintenance of EVD was 102 days (10 days-1 year). Finally, three ventriculoperitoneal (VP) valveless systems, one with antigravitation device, and one Pro-GAV VP shunt were placed, all of them with larger custom-made peritoneal catheters. After a mean follow-up period of 2.3 years (6 months-3 years), two patients are completely recovered, one patient is partially dependent for daily activities with good cognitive status, and the last one is a child who died due to his brain tumor.
  
  
  CONCLUSIONS
  The custom-made peritoneal catheters with larger inner diameter could be a good option for the management of this complex pathology.
authors.affiliation: Neurosurgery Department, Cruces University Hospital, Bilbao, Spain, lara.galbarriatugutierrez@osakidetza.net.
authors.forename: L
authors.initials: L
authors.lastname: Galbarriatu
authors.forename: M
authors.initials: M
authors.lastname: Rivero-Garvía
authors.forename: M
authors.initials: M
authors.lastname: Olivares
authors.forename: D
authors.initials: D
authors.lastname: Miranda
authors.forename: I
authors.initials: I
authors.lastname: Pomposo
authors.forename: J
authors.initials: J
authors.lastname: Márquez-Rivas
mesh_terms: D000293:Adolescent; D057785:Catheters / Q000009:adverse effects; D002552:Cerebral Ventricles / Q000473:pathology / Q000601:surgery*; D002648:Child; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000473:pathology / Q000601:surgery*; D007223:Infant; D008297:Male; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods; D011312:Pressure; D012189:Retrospective Studies; D016896:Treatment Outcome