Neurosurgical treatment of progressive posthemorrhagic ventricular dilation in preterm infants: a 10-year single-institution study

Limbrick, David D.; Mathur, Amit M.; Johnston, James M.; Munro, Rebecca; Sagar, James; Inder, Terrie E.; Park, Tae Sung; Leonard, Jeffrey L.; Smyth, Matthew D.

doi:10.3171/2010.5.peds1010

Cited by 97 publications

(102 citation statements)

References 18 publications

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“…Previous studies have not found an association between the type of device used and infection rates; however, these reports combine positive CSF cultures and positive device cultures in one outcome measure and do not separately examine incidences of positive CSF cultures and overt device infection requiring removal. 12,13,31 Despite trends in CSF culture positivity, there were no differences in the rates of device removal between the reservoir and VSGS patients. Consequently, there were reservoir patients with positive CSF cultures who were treated without readily removing the device compared with VSGS patients, which may have reflected different practice patterns between the 2 time periods.…”

Section: Infection Risksmentioning

confidence: 94%

“…Two other reports have also demonstrated a higher, but not statistically significant, rate of permanent shunting in VSGS patients. Limbrick et al 13 noted shunt rates of 75.4% in reservoir patients and 66.7% in VSGS patients. Lam and Heilman 12 found that 93.75% of their reservoir patients had VP shunts placed, compared with 71.4% of VSGS patients.…”

Section: Vp Shunting Ratesmentioning

confidence: 97%

See 1 more Smart Citation

Ventricular reservoir versus ventriculosubgaleal shunt for posthemorrhagic hydrocephalus in preterm infants: infection risks and ventriculoperitoneal shunt rate

Wang

Amin

Jallo

et al. 2014

PED

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Object The most common neurosurgical condition observed in preterm infants is intraventricular hemorrhage (IVH), which often results in posthemorrhagic hydrocephalus (PHH). These conditions portend an unfavorable prognosis; therefore, the potential for poor neurodevelopmental outcomes necessitates a better understanding of the comparative effectiveness of 2 temporary devices commonly used before the permanent insertion of a ventriculoperitoneal (VP) shunt: the ventricular reservoir and the ventriculosubgaleal shunt (VSGS). Methods The authors analyzed retrospectively collected information for 90 patients with IVH and PHH who were treated with insertion of a ventricular reservoir (n = 44) or VSGS (n = 46) at their institution over a 14-year period. Results The mean gestational age and weight at device insertion were lower for VSGS patients (30.1 ± 1.9 weeks, 1.12 ± 0.31 kg) than for reservoir patients (31.8 ± 2.9 weeks, 1.33 ± 0.37 kg; p = 0.002 and p = 0.004, respectively). Ventricular reservoir insertion was predictive of more CSF taps prior to VP shunt placement compared with VSGS placement (10 ± 8.7 taps vs 1.6 ± 1.7 taps, p < 0.001). VSGS patients experienced a longer time interval prior to VP shunt placement than reservoir patients (80.8 ± 67.5 days vs 48.8 ± 26.4 days, p = 0.012), which corresponded to VSGS patients gaining more weight by the time of shunt placement than reservoir patients (3.31 ± 2.0 kg vs 2.42 ± 0.63 kg, p = 0.016). Reservoir patients demonstrated a trend toward more positive CSF cultures compared with VSGS patients (n = 9 [20.5%] vs n = 5 [10.9%], p = 0.21). There were no significant differences in the rates of overt device infection requiring removal (reservoir, 6.8%; VSGS, 6.5%), VP shunt insertion (reservoir, 77.3%; VSGS, 76.1%), or early VP shunt infection (reservoir, 11.4%; VSGS, 13.0%) between the 2 cohorts. Conclusions Although the rates of VP shunt requirement and device infection were similar between patients treated with the reservoir versus the VSGS, VSGS patients were significantly older and had achieved greater weights at the time of VP shunt insertion. The authors' results suggest that the VSGS requires less labor-intensive management by ventricular tapping; the VSGS patients also attained higher weights and more optimal surgical candidacy at the time of VP shunt insertion. The potential differences in long-term developmental and neurological outcomes between VSGS and reservoir placement warrant further study.

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Section: Infection Risksmentioning

confidence: 94%

Section: Vp Shunting Ratesmentioning

confidence: 97%

Ventricular reservoir versus ventriculosubgaleal shunt for posthemorrhagic hydrocephalus in preterm infants: infection risks and ventriculoperitoneal shunt rate

Wang

Amin

Jallo

et al. 2014

PED

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“…16 In a 10-year single-institution study, 29% of infants with severe IVH (Grades III and IV) developed symptomatic hydrocephalus requiring surgical intervention; 21% required permanent shunt insertion. 15 Ventriculoperitoneal (VP) shunt placement is the standard treatment for symptomatic PHHP after temporizing measures have enabled the patient to reach sufficient weight for definitive CSF diversion. Many studies have shown that the complication rate of ventriculoperitoneal shunts in the PHHP population is higher than that in patients with hydrocephalus from other etiologies.…”

mentioning

confidence: 99%

Endoscopic third ventriculostomy and choroid plexus cauterization in posthemorrhagic hydrocephalus of prematurity

Chamiraju

Bhatia

Sandberg

et al. 2014

PED

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Object The aim of this study was to determine the role of endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC) in the management of posthemorrhagic hydrocephalus of prematurity (PHHP) and to analyze which factors affect patient outcomes. Methods This study retrospectively reviewed medical records of 27 premature infants with intraventricular hemorrhage (IVH) and hydrocephalus treated with ETV and CPC from 2008 to 2011. All patients were evaluated using MRI before the procedure to verify the anatomical feasibility of ETV/CPC. Endoscopic treatment included third ventriculostomy, septostomy, and bilateral CPC. After ETV/CPC, all patients underwent follow-up for a period of 6–40 months (mean 16.2 months). The procedure was considered a failure if the patient subsequently required a shunt. The following factors were analyzed to determine a relationship to patient outcomes: gestational age at birth, corrected age and weight at surgery, timing of surgery after birth, grade of IVH, the status of the prepontine cistern and cerebral aqueduct on MRI, need for a ventricular access device prior to the endoscopic procedure, and scarring of the prepontine cistern noted at surgery. Results Seventeen (63%) of 27 patients required a shunt after ETV/CPC, and 10 patients did not require further CSF diversion. Several factors studied were associated with a higher rate of ETV/CPC failure: Grade IV hemorrhage, weight 3 kg or less and age younger than 3 months at the time of surgery, need for reservoir placement, and presence of a normal cerebral aqueduct. Two factors were found to be statistically significant: the patient's corrected gestational age of less than 0 weeks at surgery and a narrow prepontine cistern on MRI. The majority (83%) of ETV/CPC failures occurred in the first 3 months after the procedure. None of the patients had a complication directly related to the procedure. Conclusions Endoscopic third ventriculostomy/CPC is a safe initial procedure for hydrocephalus in premature infants with IVH and hydrocephalus, obviating the need for a shunt in selected patients. Even though the success rate is low (37%), the lower rate of complications in comparison with shunt treatment may justify this procedure in the initial management of hydrocephalus. As several of the studied factors have shown influence on the outcome, patient selection based on these observations might increase the success rate.

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“…Rather, a variety of approaches, ranging from serial lumbar punctures (LP), transcutaneous transfontanellar puncture, external ventricular drainage, and ventriculosubgaleal shunt (with or without subcutaneous reservoir) to the endoscopic third ventriculostomy are used 4,6,7,8,9,10,11,12,13 . Ventriculoperitoneal (VP) shunts are contraindicated as a first option in low birth-weight (< 1.500g) premature neonates due to the higher risk of complications associated with the implanted prosthesis and are reserved for selected cases 4,9,11,13 . The scope of this study was describing a case series of premature neonates with PHH and assessing the outcomes of different approaches used for CSF diversion.…”

Section: Introductionmentioning

confidence: 99%

Cerebrospinal fluid drainage options for posthemorrhagic hydrocephalus in premature neonates

Melo¹,

Passos²,

Carvalho³

2017

Arq. Neuro-Psiquiatr.

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Objective: The literature describes various cerebrospinal fluid (CSF) drainage techniques to alleviate posthemorrhagic hydrocephalus in preterm newborns; however, consensus has not been reached. The scope of this study was describing a case series of premature neonates with posthemorrhagic hydrocephalus and assessing the outcomes of different approaches used for CSF diversion. Methods: A consecutive review of the medical records of neonates with posthemorrhagic hydrocephalus treated with CSF drainage was conducted. Results: Forty premature neonates were included. Serial lumbar puncture, ventriculosubgaleal shunt, and ventriculoperitoneal shunt were the treatments of choice in 25%, 37.5% and 37.5% of the cases, respectively. Conclusion: Cerebrospinal fluid diversion should be tailored to each case with preference given to temporary CSF drainage in neonates with lower age and lower birth-weight, while the permanent ventriculoperitoneal shunt should be considered in healthier, higher birth-weight neonates born closer to term.Keywords: cerebral hemorrhage; hydrocephalus; cerebrospinal fluid. RESUMOObjetivo: A literatura descreve várias opções de drenagem liquórica (DL) para alivio da hidrocefalia pós-hemorrágica (HPH) em neonatos prematuros; contudo, não existe um consenso sobre a melhor abordagem. O escopo deste estudo foi descrever uma série de casos de neonatos prematuros, portadores de HPH, verificando os resultados de diferentes técnicas utilizadas para DL. Métodos: Revisão consecutiva dos prontuários de neonatos com diagnostico de HPH submetidos a DL. Resultados: Quarenta recém-nascidos prematuros foram incluídos. A punção lombar seriada (PL), a derivação ventriculosubgaleal (VSG) e a derivação ventrículo peritoneal (VP) foram o tratamento escolhido em 25%, 37,5% e 37,5% dos casos, respectivamente. Conclusão: As opções de DL devem ser avaliadas caso a caso, sendo dada preferência às drenagens temporária em prematuros com idade e peso mais baixos ao nascer, enquanto o shunt definitivo (derivação VP) pode ser considerado naqueles prematuros mais saudáveis, com idade e peso superiores.Palavras-chave: hemorragia cerebral; hidrocefalia; líquido cefalorraquidiano. Intraventricular hemorrhage (IVH) has been a major cause of mortality among premature neonates for more than 40 years 1,2 and is associated with neonatal encephalopathy, subsequent subtle apnea, and death 1,2,3,4 . Low birth-weight premature neonates are more vulnerable to IVH and, depending on the IVH grade, to posthemorrhagic hydrocephalus (PHH). Posthemorrhagic hydrocephalus can evolve to progressive PHH, and in more severe cases, to periventricular hemorrhagic infarct, hemorrhagic cerebral injury, and periventricular leukomalacia 1,4,5 . Between 15% to 20% of neonates born with a weight less than 1,500 g are estimated to develop IVH. Further, 75% of those with Papile grade III or IV hemorrhages develop progressive PHH and need a permanent shunt 4,6 .The literature does not clearly indicate any standardized protocols for the best PHH treatment o...

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Neurosurgical treatment of progressive posthemorrhagic ventricular dilation in preterm infants: a 10-year single-institution study

Cited by 97 publications

References 18 publications

Ventricular reservoir versus ventriculosubgaleal shunt for posthemorrhagic hydrocephalus in preterm infants: infection risks and ventriculoperitoneal shunt rate

Ventricular reservoir versus ventriculosubgaleal shunt for posthemorrhagic hydrocephalus in preterm infants: infection risks and ventriculoperitoneal shunt rate

Endoscopic third ventriculostomy and choroid plexus cauterization in posthemorrhagic hydrocephalus of prematurity

Cerebrospinal fluid drainage options for posthemorrhagic hydrocephalus in premature neonates

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