A flash back of my own treatment story uncovered to me that my best top condition was after the 3 days drainage test on 2007. Unfortunately I donot think that my first (35 cm) GAV was any effective. This favourable state stayed for around 6 to 8 months as long as I remember.

A precaution here have to be said:

My improvement at this time was my first impressions from darkness to light. So my question and my suggestion above might be all subjective, false and misleading. I am only putting my idea for discussion. Periodical CSF drainage is one accepted treatment. I am trying to refine its method.

We will find some neurosurgeons who say that a shunt is not the answer to hydrocephalus. I am here suggesting an alternative to those neurosurgeons and to others as well as to patients who refuse and fear to implant a shunt or need a stent.

Let's be courageous to criticise and compare the two methods of internal drainage and external drainage. If experts told us; it is a stupid suggestion supported by a reason no harm is done. It is a suggestion of a patient who passed through both. Also faced with many patients who feared shunts.

After my 3 days drainage test I remember to be in an excellent condition for around 8 months. I have good reasons to believe that shunt implanted to me GAV 35/5 had no role. My opening pressure was 24 and I was an active person (standing most on the day). Pressure gradient blocked the valve.

Based on the above, clinical trials in this direction can show us more. Let us use as a start the fear of a shunt as a reason.

We can take more precautions to decrease the risk of infection.

No shunt vagarie (csf drained is seen): overdrainage and underdrainage would be much less. We can tailor the the amount drained.

Poor people *no operation fees available) as well as fear is solved.

As much as I know external drainage is currently used in two situations:

1) 3 days drainage as a diagnostic test and not as a periodical longterm treatment.

2) If an IIH patient presented in emergency room with severe headache; a 50 To 100 ml is drained over 30 min. To 1 hour as a temporary relief.

Why not?

Patient is refusing a shunt.

Give him a 6 - 12 months relief.

After disappearance of this 6 - 12 months good effect and watches the changes in EEGs and others he will have 2 choices:

Repeating the 3 days drainage or,

To be convinced to implant a shunt.

We need to consider the fear of the shunt or cost considerations as well as his/her unsureness that he/she needs it. Many patients think I was created so in case IH started in childhood. He is unaware of the great bad effects of IH he used to very early.

For researchers, they have a golden chance to compare the effects of periodical 3 days drainage with the effects of a shunt.

I think it is dogmatic and very unwise not to give a choice between the above 2 options to those who fear shunts.

The only precaution is aspesis and assuring nil infections. Not relaxing on repeating the proceudre. Infection should be considered as a fatal and an uncceptable complication.

If I was a neurosurgeon or a neurologist this would be my plan. Being an IH patient my only authority is to suggest for those putting the guidelines.

Discussions are wellcomed and can enrich or modify this guideline.Also expressing the drawbacks warning against it helps to discourage this choice to to be offered to any IH patient.

My suggestion came to my mind as 4 IH in my own family refused to proceed for more investigations followed by a shunt.

A guideline put by authorities of "the above two options offered to an IH patient" instead of one might saved them in their way of recovery.

Surely I disagree testing by a lumbar drainage of 50 - 100 ml over a short time. It might also cause headache and discourage the patient any further proceeding. He/she is in a very sensitive suspicious unbelieving situation and a once a headache after the proceudre and suffering a headache surely would confirm against. A 5 ml/hour rate with me over 3 days did not cause any headache to me and on the contrary it relieved my head.

My best regards,

It might look superificially that shunt is obviously the superior option to think of.

But the external drainage described above leads to squzeeing out the extra csf in brain tissue. This is expected to be followed by a much normal brain tissue and working synapses until a sigificant amount of csf have been stagnant and recollected enough to reimpair synapse function again . Then a relapse after 6-12 months happens. CSF circulation is expected to behave more physiological during this period without shunt interference.

A shunt leads a constant rate of drainage all over the years. CSF circulation is not responding physiologically as shunt is interfering with normal responses and modifying them.

Comparison trials might tell us about a need to come to a combination. The shunt value would be here to help to prolong the time until a relapse happens añd then can be adjusted to the lowest possible drainage rate delaying relapse and at the same time giving csf circulation a better chance to behave more closer to physiological at this low rates.

Why do researchers for more than a decade have been trying with the electro- mechanical shunt?

I think they are trying to make shunt drainage looks changing like all other vital parameters e,g,. pulse, BP, breathing, etc,. CSF changes done with the electromechanical shunt are within a preset range according to researchers criteria. Normally CSF pressure changes are responses to normal daily variables like sleep, exercise, emotions, thinking, meditation as well as many others.

Compare shunts with the more simpler option I suggesting in my question:

Draining the accumulated csf periodically targets IH pathology at intervals. Between intervals this plan keeps csf circulation to behave nearly normal in response to daily variables.

In case a patient after one drain or after several drains accepts to implant a shunt, it can work as both an external lumbar drain (+or-) a lumbar shunt. This lumbar shunt might be set up at the lowest possible rate with the aim to prolong the periodical external drainage intervals.

Imagine a courageous and a cautious researcher is thinking to put a protocol some how based on the above plan:

I would be happy to interchange opinions with him about the points we possibly might be looking for:

1) Amount of CSF to be drained every 6- 12 months.

2) How to decide intervals for each patient.

3) Writing to companies about the lumbar implant for repeated external drain allowing a zero risk of infection.

4) Comparing serial MRIs with those of shunted patient.

5) Considering more sensitive indicators than gait test, mini mental test and scores of falls and incontinence incidents. The above are more suitable for late cases. Fundus and eye testing clearly is a must follow up in all.