Jugular Venous Compression via Soft Cervical Collar in Shunt-Refractory Low-Pressure Hydrocephalus: A Report of Two Cases

Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine

Low-pressure hydrocephalus (LPH) is a rare and heterogeneous condition characterized by refractory ventriculomegaly despite low or negative intracranial pressure, often persisting after conventional CSF diversion. Established management strategies, including shunt revision and valve adjustment, frequently fail. We describe two patients, aged 45 and 66 years, in whom ventriculomegaly could not be controlled following ventriculoperitoneal shunting without continuous manual pumping of the shunt reservoir. As a result, bilateral jugular venous compression was applied using a soft cervical collar. Both demonstrated radiographic improvement, with third ventricular width decreasing from 13 to 8 mm and 13 to 4 mm in cases 1 and 2, respectively. Pumping was subsequently discontinued. In each patient, temporary cessation of collar use was temporally associated with recurrence of ventriculomegaly, which resolved following collar reapplication in case 1; the collar was not reapplied in case 2. Bilateral jugular venous compression with a soft cervical collar may represent a low-risk adjunct in shunt-refractory LPH. The response to withdrawal and reapplication observed here supports further investigation.