Protection of the cortical mantle in premature infants with posthemorrhagic hydrocephalus
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Subcutaneous ventricular reservoirs effectively managed hydrocephalus in premature infants, stabilizing intracranial pressure and protecting brain tissue. This approach offered a temporary solution for high-risk neonates awaiting resolution of other medical issues.
Area of Science:
- Neonatology
- Pediatric Neurosurgery
- Critical Care Medicine
Background:
- Advances in neonatology enable survival of premature infants <1500g.
- Intracranial hemorrhages affect up to 70% of these infants.
- Managing posthemorrhagic hydrocephalus in medically complex neonates is challenging.
Purpose of the Study:
- To evaluate the efficacy of subcutaneous ventricular reservoirs in managing hydrocephalus in low birth weight infants.
- To protect the cortical mantle until shunting is feasible.
- To assess the reservoir's role in stabilizing high-risk neonates.
Main Methods:
- Placement of subcutaneous ventricular reservoirs in 12 low birth weight infants with progressive hydrocephalus.
- Daily cerebrospinal fluid aspirations performed in the neonatal intensive care unit.
- Infants selected based on hydrocephalus severity and failed lumbar puncture management.
Main Results:
- Hydrocephalus and increased intracranial pressure were controlled in all patients.
- Cortical mantle stabilization or increase was observed.
- Seven infants expired due to prematurity-related complications; seven eventually required shunts.
Conclusions:
- Subcutaneous ventricular reservoirs provide effective temporary management of hydrocephalus in high-risk premature infants.
- This method can stabilize neonates, protecting the brain until definitive treatment is possible.
- One patient successfully avoided shunting at one year of age.
Abstract:
Premature infants weighing under 1500 g are now surviving because of technical and medical advances in the field of neonatology. Up to 70% of these babies will have intracranial hemorrhages. The management of posthemorrhagic hydrocephalus in these children with multiple other medical problems has thus become quite significant. This paper reports the results of the placement of a subcutaneous ventricular reservoir in 12 of these low birth weight infants in an attempt to protect their cortical mantle until their medical problems resolve and the risks and complications of shunting are acceptable. The infants were selected on the basis of clinically progressive hydrocephalus, multiple medical problems, and the failure of lumbar punctures to control the hydrocephalus. The placement of the reservoir was carried out in the neonatal intensive care unit and there were daily aspirations of cerebrospinal fluid. In all of the patients the hydrocephalus and increased intracranial pressure were controlled, with a stabilization of or an increase in the cortical mantle. Seven infants died from other problems associated with their prematurity. Seven required shunts when their medical problems resolved; one, now 1 year of age, has not required a shunting procedure.