Negative-pressure hydrocephalus.

Two cases of children with closed myelodysplasia, Arnold-Chiari malformation, and shunted hydrocephalus who underwent spinal arachnoid cystopleural shunting are presented. Postoperatively, both patients developed craniovertebral symptomatology accompanied by radiologically documented ventricular dilation in spite of negative intracranial pressure and functional ventriculoperitoneal (VP) shunts. Both patients recovered after the cystopleural shunts were revised to increase the resistance to flow within the system. The authors believe that some communication between the arachnoid cyst and the subarachnoid space existed in both cases and that the negative pleural pressure was transmitted preferentially to the spinal and cerebral convexity subarachnoid spaces with relative sparing of the ventricular system. A transmantle pressure gradient was thereby established, leading to ventricular dilation. The authors further suggest that a craniospinal gradient was possibly established as well, leading to craniovertebral symptomatology in the patients. Return of flow in the VP shunts was obtained by correcting this iatrogenic transmantle pressure gradient.