Low dose intraventricular fibrinolytic treatment to prevent posthaemorrhagic hydrocephalus

Area of Science:

• Neonatal Neurology
• Pediatric Neurosurgery
• Intracranial Hemorrhage Management

Background:

• Posthaemorrhagic ventricular dilatation (PHVD) often results from intraventricular hemorrhage obstructing cerebrospinal fluid (CSF) reabsorption.
• Progressive PHVD necessitates surgical shunt placement in over 60% of affected infants, with existing treatments having significant drawbacks.

Purpose of the Study:

• To investigate the efficacy of intraventricular streptokinase infusion as a fibrinolytic therapy to restore CSF reabsorption pathways.
• To determine if streptokinase treatment can prevent the need for surgical shunt placement in infants with progressive PHVD.

Main Methods:

• A pilot study involving nine preterm infants with progressive PHVD.
• Treatment consisted of intraventricular infusion of streptokinase over 12-72 hours.
• Assessed fibrinolytic activity in ventricular and spinal fluid, and monitored for shunt requirement, infection, and rebleeding.

Main Results:

• All nine infants survived the treatment.
• Only one infant required surgical shunting, indicating high efficacy.
• A 200% increase in fibrinolytic activity was observed in both ventricular and spinal fluid.
• No infections occurred; minor rebleeding in one case was not clinically significant.

Conclusions:

• Intraventricular streptokinase infusion is a promising, direct therapeutic approach for the underlying pathology of PHVD.
• This fibrinolytic strategy effectively restores CSF pathways and significantly reduces the need for shunt surgery in infants.
• The treatment demonstrated safety and efficacy in this pilot study, offering a potential alternative to invasive procedures.