Importance of ventricle-to-brain ratio (VBR) and volume of CSF drainage in the treatment of very low pressure hydrocephalus
Bibliographic record
Abstract
Introduction: Low pressure hydrocephalus is a known complication of prolonged hydrocephalus sometimes treatable with continued low-pressure drainage at subatmospheric pressures. Clarke et. al. and Filipidis et. al. have reported poor outcomes when treating very low pressure hydrocephalus (VLPH). We present 4 cases of very low pressure hydrocephalus (VLPH) following transnasal endoscopic resection of suprasellar lesions and hypothesize that poor prognostic cases can be identified thereby avoiding prolonged futile treatments. Methods: We performed a retrospective chart review of 4 cases of VLPH and tried to identify metrics contributing to successful treatment. We examined the Pearson correlations between Glasgow Coma Scale and ventricle-to-brain ratio (VBR); volume of CSF drained; net fluids; and serum sodium, urea, and creatinine. Results: Our investigation reveals that Glasgow Coma Score is positively correlated with increased CSF drainage and negatively correlated with increased ventricle-to-brain ratio. The most important determinant of good outcome is brain compliance as measured by the brain’s ability to maintain a good GCS score in the face of wide ranges in ventricle-to-brain ratio (VBR). Conclusion: We propose that futile prolonged subatmospheric drainage be avoided by declining treatment in patients who have ventriculitis and patients who have a narrow range of ventricle-to-brain ratio (VBR) concurrent with a good neurological examination.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".