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External ventricular drainage for initial treatment of neonatal posthemorrhagic hydrocephalus: surgical and
T T Rhodes1, W H Edwards, R L Saunders
1Department of Maternal, Dartmouth-Hitchcock Medical Center, Hanover, N.H.
Insights
External ventricular drainage (EVD) for posthemorrhagic hydrocephalus in infants showed varied outcomes. While many survivors had normal cognitive function, a significant portion experienced neurodevelopmental deficits, with hemorrhage severity impacting prognosis.
Area of Science:
- Pediatric Neurosurgery
- Neonatal Neurology
- Hydrocephalus Management
Background:
- Posthemorrhagic hydrocephalus (PHH) is a serious complication in infants, often requiring intervention.
- Early management of PHH is crucial for neurodevelopmental outcomes.
- External ventricular drainage (EVD) is a common treatment modality for PHH.
Purpose of the Study:
- To evaluate the efficacy and outcomes of external ventricular drainage (EVD) in infants treated for posthemorrhagic hydrocephalus (PHH).
- To assess the neurodevelopmental status of survivors following EVD treatment for PHH.
Main Methods:
- Retrospective analysis of 37 infants treated with EVD for PHH between 1977 and 1985.
- Data collected included age at EVD placement, duration of drainage, complications, and need for permanent shunts.
- Neurodevelopmental outcomes (cognitive and neuromuscular) were evaluated at a mean age of 38 months.
Main Results:
- Complications included apnea (10%), hemorrhage (8%), and ventriculitis (6%).
- 32% of survivors did not require a permanent shunt.
- Among survivors, 67% had normal cognitive function, while 22% had moderate to profound mental retardation. Neuromuscular outcomes varied, with 33% having normal exams and 33% experiencing moderate to severe cerebral palsy.
- Worse outcomes were associated with parenchymal or large intraventricular hemorrhages.
Conclusions:
- EVD is a viable initial treatment for PHH, with a notable percentage of infants avoiding permanent shunts.
- While a majority of survivors achieve normal cognitive function, significant neurodevelopmental impairments, including cerebral palsy and visual impairment, can occur.
- The severity of the initial hemorrhage is a critical factor influencing long-term neurodevelopmental prognosis in infants with PHH treated by EVD.
Abstract:
Thirty-seven infants were treated for posthemorrhagic hydrocephalus (PHH) with external ventricular drainage (EVD) in 1977-1985. The mean age at EVD placement was 13 days; the mean duration of drainage was 21 days, and an average of 1.8 drains was used per patient. Complications were apnea (10%), hemorrhage (8%) and ventriculitis (6%). Ten infants died from pulmonary disease unrelated to the surgery. Thirty-two percent of the survivors did not require a permanent shunt. Neurodevelopmental outcome was evaluated at a mean age of 38 months. Eighteen of the twenty-seven survivors (67%) had normal cognitive function, 3 had borderline and 6 (22%) had moderate to profound mental retardation. Nine of the children (33%) had a normal neuromuscular exam. One child had mild, 11 had moderate and 6 had severe cerebral palsy. Four children had serious visual impairment. The worst outcomes were in the children with parenchymal or large intraventricular hemorrhages.