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The treatment of hydrocephalus in preterm infants with intraventricular haemorrhage
E C Benzel1, J P Reeves, P K Nguyen
1Division of Neurosurgery, University of New Mexico School of Medicine, Albuquerque.
Insights
Ventricular reservoirs offer safe, intermittent access for neonatal hydrocephalus due to intraventricular hemorrhage. This approach is a viable alternative to early shunting, potentially reducing infection and complications.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Neonatology
Background:
- Neonatal intraventricular hemorrhage (IVH) frequently leads to hydrocephalus.
- Medical management often fails in severe IVH cases (Grade III and IV), necessitating surgical intervention.
- Traditional ventriculoperitoneal shunts carry risks of infection and complications in neonates.
Purpose of the Study:
- To retrospectively evaluate the efficacy and safety of ventricular drainage procedures for hydrocephalus secondary to neonatal IVH.
- To compare outcomes between Grade III and Grade IV IVH patients.
- To assess the role of ventricular reservoirs as an alternative to early ventriculoperitoneal shunting.
Main Methods:
- Retrospective review of 41 patients with hydrocephalus due to neonatal IVH (Grades III and IV) who failed medical management.
- Analysis of ventricular drainage procedures, including the use of ventricular reservoirs (Rickham or McComb) and subsequent conversion to ventriculoperitoneal shunts.
- Evaluation of complication rates (infection, revision) and functional outcomes.
Main Results:
- No mortality was associated with neurosurgical interventions.
- 32% of patients experienced shunt/reservoir infection, and 59% required revision within the first year.
- Grade III patients had better functional outcomes (10 achieved normal levels) compared to Grade IV patients.
- Grade IV patients showed higher rates of severe developmental delay (44% vs. 28%) and death (38% vs. 12%) than Grade III patients.
Conclusions:
- Ventricular reservoirs provide acceptable, intermittent ventricular access in neonates with hydrocephalus from IVH.
- This approach may reduce shunt infections and complications compared to early ventriculoperitoneal shunt placement.
- Ventricular reservoirs are a viable alternative for managing hydrocephalus in medically refractory neonatal IVH.
Abstract:
The hospital charts and clinical course of forty-one patients requiring one or more ventricular drainage procedures for hydrocephalic complications of neonatal intraventricular haemorrhage were evaluated retrospectively. All drainage procedures were performed on patients with intraventricular haemorrhage with ventricular dilatation (Grade III [25 patients]) and intraventricular and intraparenchymal haemorrhage (Grade IV [16 patients]) who were medical management failures. Twenty-six ventricular reservoirs (Rickham or McComb reservoirs) were placed in neonates weighing less than 1500 grams, allowing for a safe but intermittent ventricular access. Eighteen of these reservoirs were subsequently converted to ventriculoperitoneal shunts. Thirty-two percent of the patients incurred a shunt and/or reservoir infection and 59% required a shunt revision during the first year of life. There was no mortality related to the neurosurgical interventions. These results compare favorably with the published literature. No grade IV patients achieved a normal functional level, while 10 grade III patients did. The incidence of severe developmental delay (44% versus 28%) and death (38% versus 12%) was greater in the grade IV than the grade III patients. The placement of ventricular reservoirs is acceptable as an alternative to the early placement of ventriculo-peritoneal shunts. This approach may reduce the incidence of shunt infection as well as noninfectious shunt complications.