Risk factors associated with conversion of an Ommaya reservoir to a permanent cerebrospinal fluid shunt in preterm posthemorrhagic hydrocephalus

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>A considerable percentage of preterm infants with posthemorrhagic hydrocephalus initially managed with an Ommaya reservoir require a permanent CSF shunt. The objective of the study was to analyze possible risk factors associated with the need for converting an Ommaya reservoir to a permanent shunt.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors retrospectively reviewed the clinical records of premature infants weighing 1500 g or less with posthemorrhagic hydrocephalus (Papile grades III and IV) managed with an Ommaya reservoir at their institution between 2002 and 2017.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Forty-six patients received an Ommaya reservoir. Five patients (10.9%) were excluded due to intraventricular infection during management with an Ommaya reservoir. Average gestational age and weight for the remaining 41 patients was 27 ± 1.8 weeks and 987 ± 209 grams, respectively. Thirty patients required a permanent shunt and 11 patients did not require a permanent shunt. The conversion rate from an Ommaya reservoir to a permanent shunt was 76.1%. Symptomatic persistent ductus arteriosus (PDA) was more frequent in the nonpermanent shunt group than in the shunt group (88.9% vs 50%, p = 0.04). The need for extraction of more than 10 ml/kg per day of CSF through the Ommaya reservoir was lower in the nonpermanent shunt group than in the shunt group (9.1% vs 51.7%, p = 0.015). CSF lactate was lower in the nonpermanent group than in the shunt group (mean 2.48 mg/dl vs 3.19 mg/dl; p = 0.004). A cutoff value of ≥ 2.8 mg/dl CSF lactate predicted the need for a permanent shunt with sensitivity and specificity of 82.4% and 80%, respectively. There were no significant differences in gestational age, sex, weight, Papile grade, ventricular index, or other biochemical markers. After the multivariate analysis, only CSF lactate ≥ 2.8 mg/dl was associated with a higher conversion rate to a permanent shunt.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>This study showed that a high level of CSF lactate, absence of symptomatic PDA, and a higher CSF extraction requirement were associated with a higher likelihood of implanting a permanent CSF shunt. The authors believe these findings should be considered in future studies.</jats:p></jats:sec>

Combination of Conventional EVD and Ommaya Drainage for Intraventricular Hemorrhage (IVH)

“…Reducing the number of patients who need permanent CSF diversion may potentially decrease the amount of shunt complications, the incidence of poor neurological outcomes and overall health-care costs. [27][28][29] In our study, 25% of the IVH patients ultimately underwent permanent hydrocephalus shunt surgery, and this finding is basically consistent with previous literature reports. The early removal of conventional EVD followed by the use of an Ommaya reservoir for CSF drainage likely reduces the need for a permanent VP shunt.…”

The Cost of Serial Cerebrospinal Fluid Aspirations between Ventricular Access Device and Ventriculosubgaleal Shunt for Treatment of Posthemorrhagic Ventricular Dilatation in Premature Infants

“…Only one study that reported on VSGS mentioned labs, only that they were sent prior to VPS insertion [10]. For VADs, three studies explicitly stated that labs were sent after every aspiration [6, 11, 12], one study stated that “clinical investigations followed the punctures” [13], three studies from two research groups merely stated that labs were done “routinely” [14-16], one study “three times per week” [17], one study “at least once a week” [18], two studies “weekly” [19, 20], one study “at 5- to 8-day intervals” [21], and one study just that labs were sent [22].…”