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Updated: Aug 3, 2025
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Published on: October 14, 2022
Permanent Surgical Treatment for Posthemorrhagic Hydrocephalus in Preterm Infants
1Department of Pediatric Neurosurgery, Takatsuki General Hospital, Osaka, Japan.
Insights
Posthemorrhagic hydrocephalus (PHH) management often requires permanent cerebrospinal fluid diversion. Endoscopic third ventriculostomy is increasingly used, offering an alternative to shunts with high complication rates.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Hydrocephalus Research
Background:
- Posthemorrhagic hydrocephalus (PHH) is a common complication in premature infants.
- Current management for PHH involves temporary measures like ventricular drainage or shunts.
- A significant percentage of PHH patients require permanent cerebrospinal fluid diversion.
Purpose of the Study:
- To review the latest evidence on permanent treatment options for posthemorrhagic hydrocephalus.
- To compare the efficacy and complication rates of different PHH management strategies.
- To highlight the growing role of neuroendoscopic procedures in PHH treatment.
Main Methods:
- Literature review of studies on permanent treatment for PHH.
- Analysis of data on shunt placement and endoscopic third ventriculostomy (ETV) in PHH patients.
- Evaluation of complication rates and long-term outcomes for various interventions.
Main Results:
- Shunt placement remains a common permanent treatment for PHH but is associated with high complication rates.
- Endoscopic third ventriculostomy (ETV), with or without choroid plexus cauterization, is increasingly utilized for PHH.
- ETV offers a potentially less invasive alternative to permanent shunting.
Conclusions:
- The optimal permanent treatment for PHH is still under investigation.
- Neuroendoscopic techniques like ETV are emerging as viable alternatives to traditional shunting for PHH.
- Further research is needed to establish the long-term efficacy and safety of ETV in PHH management.
Abstract:
While the standard management for posthemorrhagic hydrocephalus (PHH) has not been determined, many patients initially receive temporary treatment such as a ventricular drainage, a ventricular reservoir, or a ventriculosubgaleal shunt. Subsequently, approximately 15% of patients with PHH will require permanent cerebrospinal fluid diversion. Shunt placement is most commonly performed for PHH as permanent treatment. However, shunting still has high complication rates. Since the development of the neuroendoscopic technique has progressed, and indication has been expanded, endoscopic third ventriculostomy with or without choroid plexus cauterization has performed more frequently in recent years in patients with PHH. In this paper, the permanent treatment for PHH will be reviewed based on the latest evidence.
