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Current methods in the treatment of posthemorrhagic hydrocephalus in infants
1Department of Pediatric Neurosurgery, University Hospital Motol, Prague, Czech Republic. dhori@email.cz
Insights
Managing infant posthemorrhagic hydrocephalus presents challenges due to high risks. Current treatments for this condition have drawbacks, necessitating further research into optimal infant hydrocephalus management.
Area of Science:
- Pediatric Neurosurgery
- Neonatal Medicine
- Neurology
Background:
- Posthemorrhagic hydrocephalus in infants is a serious condition with significant mortality and morbidity.
- Survivors often face variable rates of developmental delay, cerebral palsy, epilepsy, and visual impairment.
- Existing treatment modalities for infant hydrocephalus carry substantial drawbacks.
Purpose of the Study:
- To review and analyze recent methods and approaches for managing posthemorrhagic hydrocephalus in infants.
- To evaluate the efficacy and limitations of various treatment options.
- To identify areas requiring further investigation in infant hydrocephalus management.
Main Methods:
- Literature review of recent studies on posthemorrhagic hydrocephalus management.
- Analysis of treatment outcomes, including efficacy, complications, and drawbacks.
- Comparison of different interventions such as lumbar punctures, external ventricular drainage, subcutaneous reservoirs, intraventricular fibrinolytic therapy, shunting, and endoscopic procedures.
Main Results:
- Repeated lumbar punctures have high infection rates and may be insufficient for cerebrospinal fluid drainage.
- External ventricular drainage and subcutaneous reservoirs offer better cerebrospinal fluid evacuation but may not fully control intracranial pressure.
- Intraventricular fibrinolytic therapy shows promise but requires more extensive research.
- Permanent ventricular shunting is common, with programmable valves potentially offering advantages.
- Endoscopic procedures are preferred for compartmentalized hydrocephalus.
- Conservative treatments with acetazolamide and furosemide do not appear beneficial.
Conclusions:
- No single treatment for posthemorrhagic hydrocephalus in infants is without significant drawbacks.
- Further research is needed, particularly for intraventricular fibrinolytic therapy.
- Programmable valve shunts and endoscopic procedures represent advancements in managing complex infant hydrocephalus cases.
Abstract:
The authors reviewed the most recent methods and approaches in the management of posthemorrhagic hydrocephalus in infants. Posthemorrhagic hydrocephalus in infants is associated with a high mortality and morbidity. The incidence of developmental delay, cerebral palsy, epilepsy end visual impairment in surviving children is variable. All treatments have significant drawbacks. Repeated lumbar punctures are frequently associated with high rate of infection and the amount of cerebrospinal fluid drained may be insufficient. External ventricular drainage appears to be more effective than lumbar punctures in evacuating sufficient volumes of cerebrospinal fluid. With subcutaneous reservoir the withdrawal of a sufficient volume of cerebrospinal fluid is achieved, but intermittent elevations of intracranial pressure still occur. Intraventricular fibrinolytic therapy is a promising method in the management of posthemorrhagic hydrocephalus, however more studies with larger numbers of patients are needed. The most common treatment of posthemorrhagic hydrocephalus involves permanent ventricular shunting. Shunts with a programmable valve seem to be superior to other shunt systems. In case of compartmentalization endoscopic procedures are preferred. Conservative treatment with acetazolamide and furosemide does not seem to confer any advantage to the management of posthemorragic hydrocephalus. (Tab. 2, Fig. 2, Ref. 26.)
