Correct understanding of the definition and management strategies for refractory hydrocephalus
Abstract Hydrocephalus refers to the abnormal accumulation of cerebrospinal fluid (CSF) in the central nervous system, typically resulting from an imbalance between CSF production and absorption. Traditional classifications of hydrocephalus do not incorporate management strategies (not classified ac...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-08-01
|
| Series: | Chinese Neurosurgical Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s41016-025-00403-9 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849735946036051968 |
|---|---|
| author | Zhixiong Lin Hua Feng Wangming Zhang Gelei Xiao Jingyu Chen Zhiqiang Liu |
| author_facet | Zhixiong Lin Hua Feng Wangming Zhang Gelei Xiao Jingyu Chen Zhiqiang Liu |
| author_sort | Zhixiong Lin |
| collection | DOAJ |
| description | Abstract Hydrocephalus refers to the abnormal accumulation of cerebrospinal fluid (CSF) in the central nervous system, typically resulting from an imbalance between CSF production and absorption. Traditional classifications of hydrocephalus do not incorporate management strategies (not classified according to the degree of difficulty of treatment). Clinically, hydrocephalus that is challenging to treat is often categorized as refractory hydrocephalus (RH). However, the absence of a unified definition of RH impedes the standardization of treatment approaches, raising clinical dilemmas. This article explores the definition, etiologies, classification, and management strategies for RH. Based on the literature and the Diagnosis-Related Group payment system principles, RH is clinically defined as progressive hydrocephalus meeting one or more of the following criteria: (1) the absence of significant clinical or radiological improvement within 60 days despite standard interventions, usually due to pathological factors, such as abnormal CSF characteristics, (2) inability to achieve curative surgical treatments attributable to complex anatomy such as abnormal dynamic changes or multiloculated compartments, and (3) failure to respond after two consecutive therapeutic procedures. RH consists of six distinct subtypes, with infectious hydrocephalus being the most common, followed by low-pressure hydrocephalus. Temporary management strategies for RH must be carefully tailored to patient-specific characteristics, considering the risk–benefit analysis of available measures. In cases of infectious RH, achieving CSF sterilization and evaluating the results are crucial. Curative surgery for infectious RH should be performed only after CSF has been completely sterilized to normal levels. In low-pressure RH, a critical focus is identifying and addressing the sites receiving CSF. |
| format | Article |
| id | doaj-art-34bc8194c86f43bf851cb113bbdcd431 |
| institution | DOAJ |
| issn | 2057-4967 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Chinese Neurosurgical Journal |
| spelling | doaj-art-34bc8194c86f43bf851cb113bbdcd4312025-08-20T03:07:24ZengBMCChinese Neurosurgical Journal2057-49672025-08-011111910.1186/s41016-025-00403-9Correct understanding of the definition and management strategies for refractory hydrocephalusZhixiong Lin0Hua Feng1Wangming Zhang2Gelei Xiao3Jingyu Chen4Zhiqiang Liu5Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, BeijingDepartment of Neurosurgery, Southwest Hospital, Third Military Medical UniversityThe National Key Clinical Specialty, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Center, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, The Neurosurgery Institute of Guangdong Province, Southern Medical UniversityDepartment of Neurosurgery, Xiangya Hospital, Central South University, ChangshaDepartment of Neurosurgery, Southwest Hospital, Third Military Medical UniversityDepartment of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, BeijingAbstract Hydrocephalus refers to the abnormal accumulation of cerebrospinal fluid (CSF) in the central nervous system, typically resulting from an imbalance between CSF production and absorption. Traditional classifications of hydrocephalus do not incorporate management strategies (not classified according to the degree of difficulty of treatment). Clinically, hydrocephalus that is challenging to treat is often categorized as refractory hydrocephalus (RH). However, the absence of a unified definition of RH impedes the standardization of treatment approaches, raising clinical dilemmas. This article explores the definition, etiologies, classification, and management strategies for RH. Based on the literature and the Diagnosis-Related Group payment system principles, RH is clinically defined as progressive hydrocephalus meeting one or more of the following criteria: (1) the absence of significant clinical or radiological improvement within 60 days despite standard interventions, usually due to pathological factors, such as abnormal CSF characteristics, (2) inability to achieve curative surgical treatments attributable to complex anatomy such as abnormal dynamic changes or multiloculated compartments, and (3) failure to respond after two consecutive therapeutic procedures. RH consists of six distinct subtypes, with infectious hydrocephalus being the most common, followed by low-pressure hydrocephalus. Temporary management strategies for RH must be carefully tailored to patient-specific characteristics, considering the risk–benefit analysis of available measures. In cases of infectious RH, achieving CSF sterilization and evaluating the results are crucial. Curative surgery for infectious RH should be performed only after CSF has been completely sterilized to normal levels. In low-pressure RH, a critical focus is identifying and addressing the sites receiving CSF. https://doi.org/10.1186/s41016-025-00403-9HydrocephalusDiagnosisTreatmentRefractory |
| spellingShingle | Zhixiong Lin Hua Feng Wangming Zhang Gelei Xiao Jingyu Chen Zhiqiang Liu Correct understanding of the definition and management strategies for refractory hydrocephalus Chinese Neurosurgical Journal Hydrocephalus Diagnosis Treatment Refractory |
| title | Correct understanding of the definition and management strategies for refractory hydrocephalus |
| title_full | Correct understanding of the definition and management strategies for refractory hydrocephalus |
| title_fullStr | Correct understanding of the definition and management strategies for refractory hydrocephalus |
| title_full_unstemmed | Correct understanding of the definition and management strategies for refractory hydrocephalus |
| title_short | Correct understanding of the definition and management strategies for refractory hydrocephalus |
| title_sort | correct understanding of the definition and management strategies for refractory hydrocephalus |
| topic | Hydrocephalus Diagnosis Treatment Refractory |
| url | https://doi.org/10.1186/s41016-025-00403-9 |
| work_keys_str_mv | AT zhixionglin correctunderstandingofthedefinitionandmanagementstrategiesforrefractoryhydrocephalus AT huafeng correctunderstandingofthedefinitionandmanagementstrategiesforrefractoryhydrocephalus AT wangmingzhang correctunderstandingofthedefinitionandmanagementstrategiesforrefractoryhydrocephalus AT geleixiao correctunderstandingofthedefinitionandmanagementstrategiesforrefractoryhydrocephalus AT jingyuchen correctunderstandingofthedefinitionandmanagementstrategiesforrefractoryhydrocephalus AT zhiqiangliu correctunderstandingofthedefinitionandmanagementstrategiesforrefractoryhydrocephalus |