Relation between TGF-beta 1 levels in cerebrospinal fluid and ETV outcome in premature newborns with posthemorrhagic hydrocephalus.
OBJECTIVE
Therapy of posthaemorrhagic hydrocephalus (PHH) by using ventriculo-peritoneal drainage bears considerable rate of complications and remains a challenge in premature newborns. The role of endoscopic third ventriculostomy (ETV) in these patients is unclear, through obstruction is proven in some patients with PHH. Transforming growth factor beta 1 (TGF-beta1) release into the cerebrospinal fluid (CSF) in time of primary bleeding is suggested as one of the possible pathophysiologic reasons of PHH formation. Relation between TGF-beta1 levels and ETV success rate has not been reported yet. The aim of our study is to detect group of patients, according to the levels of TGF-beta1, who have magnetic resonance imaging (MRI)-proven obstruction hydrocephalus without participation of hyporesorption-so that we can expect success of ETV.


METHODS
We followed 29 premature newborns with PHH during 2005-2007, all of them treated by Ommaya reservoir implantation and repeated taps with TGF-beta1 levels examination. In case of persisting hydrocephalus, MRI was performed. In 16 patients with proven obstruction, ETV was performed. We were successful in six patients (37,5%). We evaluated pathophysiological type of hydrocephalus and ETV succes rate and their relation to TGF-beta1 CSF levels.


RESULTS
We have proven statistically relevant probability in diagnosis of hyporesorptive hydrocephalus based on TGF-beta1 level in CSF. Value exceeding 3,296 pg/ml means 81,3% probability of present hyporesorption. Success rate of ETV in patients with MRI-verified obstruction and TGF-beta1 level lower than 3,296 pg/ml was 100% in our series.


CONCLUSIONS
TGF-beta1 level indicates participation of hyporesorption in hydrocephalus development and its level may influence decision making in ETV for premature newborns with PHH.
Lipina
Radim
R
Department of Neurosurgery, University Hospital Ostrava, 17. listopadu 1790, Ostrava-Poruba, 708 52, Czech Republic. rlipina@volny.cz
Reguli
Stefan
S
Novácková
Ludmila
L
Podesvová
Hana
H
Brichtová
Eva
E
D000465:Algorithms; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D006849:Hydrocephalus / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000601:surgery*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000134:cerebrospinal fluid*; D020300:Intracranial Hemorrhages / Q000150:complications*; D008279:Magnetic Resonance Imaging; D044583:Neuroendoscopy / Q000379:methods; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D053773:Transforming Growth Factor beta1 / Q000134:cerebrospinal fluid*; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000295:instrumentation / Q000379:methods
D053773:Transforming Growth Factor beta1