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Neurosurgical management of intraventricular haemorrhage in preterm infants
N Rahman1, W R Murshid, Z A Jamjoom
1Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
Insights
This review of intraventricular hemorrhage (IVH) in preterm infants found that post-hemorrhagic hydrocephalus (PHH) often requires surgical intervention. External ventricular drainage (EVD) proved effective for managing PHH and intracranial pressure.
Area of Science:
- Neonatal Neurology
- Pediatric Neurosurgery
Background:
- Intraventricular hemorrhage (IVH) is a significant concern in preterm infants.
- Post-hemorrhagic hydrocephalus (PHH) is a common complication of IVH, characterized by ventriculomegaly and increased intracranial pressure.
Observation:
- A 10-year review identified 103 preterm infants with IVH, 37 of whom developed PHH.
- Management strategies included external ventricular drainage (EVD), ventriculo-peritoneal shunting, lumbar punctures, and subcutaneous ventricular reservoirs.
Findings:
- External ventricular drainage (EVD) demonstrated effectiveness and safety in managing rapidly progressive PHH and elevated intracranial pressure.
- The severity of IVH, the grade of PHH, and the timeliness of neurosurgical intervention were critical determinants of patient outcomes.
Implications:
- Prompt neurosurgical management is crucial for improving neurodevelopmental outcomes in preterm infants with IVH and PHH.
- Understanding the correlation between hemorrhage grade, PHH severity, and neurodevelopmental handicap can guide clinical decision-making.
Abstract:
A review of intraventricular haemorrhage (IVH) diagnosed in 103 preterm infants from 1983 to 1993 describes the presenting features and management of this condition. In this 10-year period, 37 infants with IVH developed post-haemorrhagic hydrocephalus (PHH), defined as ventriculomegaly, raised intracranial pressure and increasing head circumference. PHH was treated by external ventricular drainage and/or ventriculo-peritoneal shunting; but other drainage procedures like lumbar punctures and subcutaneous ventricular reservoir were used occasionally. Relative indications, merits and demerits of these various surgical options is discussed and results summarized. High incidence of neuro-developmental handicap and its correlation with the grade of haemorrhage and PHH is emphasized. External ventricular drainage (EVD) was found to be an effective and safe therapy for rapidly progressive PHH and increased intracranial pressure. Ultimate outcome depended mainly on the grade of haemorrhage, severity of PHH and promptness of its neurosurgical management.