Surgical management of hydrocephalus secondary to intraventricular hemorrhage in the preterm infant

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Posthemorrhagic hydrocephalus (PHH) in the preterm infant remains a major neurological complication of prematurity. The authors first described insertion of a specially designed low-profile subcutaneous ventricular catheter reservoir for temporary management of hydrocephalus in 1983. This report presents the follow-up experience with the surgical management of PHH in this population and describes outcomes both in infants who were stable for permanent shunt insertion and those initially temporized with a ventricular reservoir (VR) prior to permanent ventriculoperitoneal (VP)/ventriculoatrial (VA) shunt placement.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A retrospective review was undertaken of the medical records of all premature infants surgically treated for posthemorrhagic hydrocephalus (PHH) between 1997 and 2012 at Children’s Hospital Los Angeles.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Over 14 years, 91 preterm infants with PHH were identified. Fifty neonates received temporizing measures via a VR that was serially tapped for varying time periods. For the remaining 41 premature infants, VP/VA shunt placement was the first procedure. Patients with a temporizing measure as their initial procedure had undergone CSF diversion significantly earlier in life than those who had permanent shunting as the initial procedure (29 vs 56 days after birth, p &lt; 0.01). Of the infants with a VR as their initial procedure, 5/50 (10%) did not undergo subsequent VP/VA shunt placement. The number of shunt revisions and the rates of loculated hydrocephalus and shunt infection did not statistically differ between the 2 groups.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Patients with initial VR insertion as a temporizing measure received a CSF diversion procedure significantly earlier than those who received a permanent shunt as their initial procedure. Otherwise, the outcomes with regard to shunt revisions, loculated hydrocephalus, and shunt infection were not different for the 2 groups.</jats:p></jats:sec>

Predictors of mortality for preterm infants with intraventricular hemorrhage: a population-based study

“…Most studies on IVH outcomes have relied on single-institution data, collaborative networks, or patient registries, but there is a dearth of longitudinal, population-level data regarding IVH [8, 17, 23, 25, 34, 43]. Few studies have investigated the long-term neurosurgical outcomes of infants affected with IVH, such as shunt complications [2, 9, 10, 21, 29, 30, 39, 40].…”

Early endoscopic ventricular irrigation for the treatment of neonatal posthemorrhagic hydrocephalus. a feasible treatment option or not ? -a multi center report-

“…PHH (16). In the literature, the ratio of cases with posthemorrhagic ventriculomegaly that require treatment has been reported in a range of 25% to 50% (5,15). Currently no medications are recommended to treat symptomatic PHH and, on the other hand, there is no solid consensus on the timing and the optimal surgical technique for PHH (1,2,5,18,30).…”

“…Today, several initial treatment techniques are preferred for progressive posthemorrhagic ventriculomegaly in neonates who suffered from IVH. These interventions include serial cerebrospinal fluid (CSF) tapping (lumbar puncture or ventricular tap), external ventricular drainage, ventricular access devices, ventriculosubgaleal shunt and endoscopic ventricular irrigation (2,5,20). There is still debate about the most feasible approach for PHH and the results of the studies that compare the effectivity of the forementioned techniques are not concordant.…”

“…There is still debate about the most feasible approach for PHH and the results of the studies that compare the effectivity of the forementioned techniques are not concordant. Most of the previous reports recommended multi-center works and larger series for more clear conclusions (1,2,5,15,18). Designed as a multi-center study with larger number of cases, the present work aims to compare the results of those management techniques for the initial treatment of PHH secondary to IVH in neonates.…”

Time-to-event analysis of surgically treated posthemorrhagic hydrocephalus in preterm infants: a single-institution retrospective study

“…Likewise, Karas et al reported VSGS at median 25 days of life (30.3 weeks EGA, n = 10) and VPS placement at 61 days of life (n = 9) [12]. Christian et al found in 91 patients that those receiving a VR or VSGS as initial procedure did so at a mean age of 29 days, and initial permanent shunt by 56 days [7]. Our results are consistent with these studies (median 24 days for VR and VSGS).…”