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External ventricular drainage for treatment of rapidly progressive posthemorrhagic hydrocephalus
M Weninger1, H R Salzer, A Pollak
1Department of Neonatology, University Children's Hospital, Vienna, Austria.
Insights
External ventricular drainage effectively managed rapidly progressive hydrocephalus in newborns. While safe, long-term outcomes depend on the initial brain injury severity.
Area of Science:
- Neonatal Neurology
- Pediatric Neurosurgery
- Critical Care Medicine
Background:
- Posthemorrhagic hydrocephalus is a serious condition in newborns, often leading to increased intracranial pressure.
- Rapidly progressive hydrocephalus requires timely and effective intervention to prevent neurological damage.
Purpose of the Study:
- To evaluate the efficacy and safety of external ventricular drainage (EVD) in neonates with rapidly progressive posthemorrhagic hydrocephalus.
- To assess the short-term and long-term outcomes of EVD treatment in this vulnerable population.
Main Methods:
- Twenty-seven newborn infants with rapidly progressive hydrocephalus and increased intracranial pressure underwent EVD.
- Drainage duration averaged 23 days, with cerebrospinal fluid and catheter tip cultures performed to monitor for infection.
- Patient outcomes, including hydrocephalus recurrence, need for shunt implantation, and neurological development, were tracked.
Main Results:
- EVD successfully arrested hydrocephalus progression in all treated infants during the drainage period.
- Recurrence of ventricular dilation occurred in 16 of 23 survivors after drainage removal, necessitating shunt placement.
- No significant ventriculitis was observed, and mortality was unrelated to the EVD procedure; neurological outcomes varied based on primary brain lesion severity.
Conclusions:
- External ventricular drainage is an effective and safe initial therapy for rapidly progressive posthemorrhagic hydrocephalus in neonates.
- The long-term neurological and developmental prognosis is primarily determined by the extent and nature of the initial brain injury.
- A significant proportion of infants may require subsequent shunt implantation due to hydrocephalus recurrence.
Abstract:
Twenty-seven newborn infants (birth weight, 1503 +/- 776 g; gestational age, 31 +/- 3 wk) (mean +/- standard deviation) with rapidly progressive posthemorrhagic hydrocephalus and increased intracranial pressure were treated by external ventricular drainage. The progression of hydrocephalus was arrested during the drainage period in each patient. The drainage was kept in place for 23 +/- 9 days, the longest drainage period being 48 days. In 16 of 23 surviving patients, progressive ventricular dilation recurred after removal of the drainage, requiring a definitive shunt implantation (nine ventriculoatrial, seven ventriculoperitoneal). For the remaining seven infants, no further therapy was necessary. Implantation of the permanent shunt was done days 28 to 88 (body weight, 2400 +/- 950 g). Bacterial cultures from cerebrospinal fluid and/or the tip of the ventriculostomy catheter were negative in 175 instances and positive in 11 instances (7 patients). No clinical or biochemical evidence of ventriculitis was noted. Four of the 27 patients died of causes unrelated to external ventricular drainage. Twenty-three infants survived. Seventeen of 23 survivors suffered from intraventricular hemorrhage Grade 3; in 7, neurological and developmental outcomes were classified as normal; 9 patients experienced mild to moderate paresis and/or mild to moderate developmental delay; and only 1 patient was severely retarded. Six patients with parenchymal lesions had severe motor and/or developmental handicaps. We consider external ventricular drainage an effective and safe therapy in newborn infants with rapidly progressive posthemorrhagic hydrocephalus and increased intracranial pressure. The ultimate outcome, however, depends mainly on the mode and the extent of the primary brain lesion.