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Clinical Experience of Infantile Posthemorrhagic Hydrocephalus Treated with Ventriculo-Peritoneal Shunt
1Department of Neurosurgery, Daegu Catholic University College of Medicine, Daegu, Korea.
Insights
Infantile posthemorrhagic hydrocephalus (IPHH) treatment using ventriculo-peritoneal (VP) shunts in preterm infants showed mixed outcomes. Varied management approaches are necessary for this condition.
Area of Science:
- Pediatric Neurosurgery
- Neonatal Neurology
- Hydrocephalus Research
Background:
- Infantile posthemorrhagic hydrocephalus (IPHH) is a common cause of acquired hydrocephalus in infants.
- Germinal matrix hemorrhage is a frequent etiology of IPHH in preterm neonates.
Purpose of the Study:
- To present and discuss the treatment experience of six IPHH patients using ventriculo-peritoneal (VP) shunts.
- To analyze the outcomes and complications associated with VP shunt placement in preterm infants with IPHH.
Main Methods:
- Retrospective analysis of six preterm infants with IPHH treated with VP shunts.
- Initial management involved external ventricular drainage (EVD) for symptomatic ventricular dilatation.
- VP shunt placement was considered if EVD did not improve ventricular index.
Main Results:
- The study included six preterm infants (mean gestational age 25 weeks) with varying grades of germinal matrix hemorrhage.
- Complications occurred in 33.3% of patients undergoing EVD (ventriculitis, abscess) and 33.3% with VP shunts.
- Neurodevelopmental outcomes ranged from severe delay in three patients to normal development in one.
Conclusions:
- Treatment of IPHH with VP shunts in preterm infants presents significant challenges.
- Varied and individualized management strategies are essential for optimizing outcomes in IPHH patients.
Objective:
Infantile posthemorrhagic hydrocephalus (IPHH) is the most common cause of infantile acquired hydrocephalus. We present and discuss our experience of treatment of six IPHH patients treated by a ventriculo-peritoneal (VP) shunt.
Methods:
Six preterm infants treated by a VP shunt due to germinal matrix hemorrhage and hydrocephalus were included in our study. External ventricular drainage (EVD) was performed in patients with symptomatic ventricular dilatation, and a VP shunt was placed in the case of no improvement of the ventricular index despite several rounds of EVD. Radiographic findings and surgical outcomes were analyzed retrospectively.
Results:
Four patients were male and two were female. Mean gestational age was 25 weeks and mean weight at birth was 868.3 g. One patient had a Papile grade II (16.7%) hemorrhage, three had a grade III (50%) hemorrhage, and two had a grade IV (33.3%) hemorrhage. EVD complications (one case of ventriculitis and one case of a ventricular abscess) occurred in two patients. VP shunt complications occurred in two patients (33.3%). Three cases had an isolated 4th ventricle; two of these cases had a VP shunt placed whereas the other case had a VP shunt placed in addition to aqueductoplasty using a neuroendoscope. At the last follow-up, three of the six patients had severe neurodevelopmental delay, two had mild neurodevelopmental delay, and one had normal development status.
Conclusion:
In our study, although it is difficult to present the significant result for management of IPHH, we think that varied efforts are required to treat IPHH patients.
