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Posthemorrhagic hydrocephalus in extremely low birth weight infants: Ommaya reservoir vs. ventriculoperitoneal shunt

Ralf-Bodo Tröbs1, Volker Sander

  • 1Klinik für Kinderchirurgie, Marienhospital Herne, St. Elisabeth Gruppe Rhein-Ruhr, Ruhr-Universität Bochum, Widumer Str. 8, D-44627, Herne, Germany, ralf-bodo.troebs@marienhospital-herne.de.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|May 29, 2015
PubMed

Insights

Early cerebrospinal fluid reservoir (CSF-R) insertion in infants with posthemorrhagic hydrocephalus (PHH) stabilized patients, delaying ventriculoperitoneal shunt (VPS) placement. Some infants achieved shunt independence, while others benefited from initial VPS.

Area of Science:

  • Neonatal surgery
  • Pediatric neurosurgery
  • Hydrocephalus management

Background:

  • Posthemorrhagic hydrocephalus (PHH) is a serious complication in premature infants following intraventricular hemorrhage (IVH).
  • Effective management strategies are crucial to minimize neurological damage and improve outcomes.

Purpose of the Study:

  • To compare the morbidity and initial surgical outcomes of infants with PHH treated with a subcutaneous cerebrospinal fluid reservoir (CSF-R) versus primary ventriculoperitoneal shunt (VPS) placement.
  • To evaluate the effectiveness of early CSF-R insertion in stabilizing infants and postponing definitive shunting.

Main Methods:

  • Retrospective analysis of infants born between 2006 and 2014 diagnosed with IVH and requiring surgical intervention for hydrocephalus.
  • Comparison of outcomes between infants receiving primary CSF-R (n=18) and primary VPS (n=7).
  • Analysis included gestational age, birth weight, umbilical artery pH, Apgar scores, and IVH grades.

Main Results:

  • Twenty-five infants with a median gestational age of 26.5 weeks and birth weight of 980g were included.
  • Significant differences were observed in postnatal age at surgery between the CSF-R (32.5 days) and VPS (163 days) groups.
  • Eleven percent of infants in the CSF-R group achieved shunt independence.

Conclusions:

  • Early CSF-R insertion can stabilize infants with PHH, allowing for delayed VPS placement.
  • Primary VPS insertion may be suitable for a subgroup of patients with a more prolonged PHH course.
  • The choice of initial surgical management should be individualized based on the infant's clinical presentation and disease progression.
Abstract

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