title: The initial neurosurgical interventions for the treatment of posthaemorrhagic hydrocephalus in preterm infants: A focused review.
abstract: BACKGROUND
  Post-haemorrhagic hydrocephalus (PHH), a potential consequence of grade II-IV germinal matrix haemorrhage, remains a significant problem in premature infants with long-term neurodevelopmental disabilities and high mortality rates. Early ventriculoperitoneal shunt (VPS) insertion is associated with a high failure rate and many complications; hence, temporising measures are always instituted until the infant is mature (age and/or weight) enough.
  
  
  METHODS
  We have reviewed the recently available literature on the usefulness and complications of the initial measures used in the treatment of PHH; particularly, focusing on serial cerebrospinal fluid (CSF) tapping, external ventricular drainage (EVD), ventriculosubgaleal shunts (VSG), ventricular access devices (VADs), endoscopic third ventriculostomy (ETV) with and without coagulation of the choroid plexus.
  
  
  RESULTS
  Randomised controlled trials (RCTs) have failed to demonstrate a significant effect of serial lumbar punctures on the rates of morbidity, mortality or conversion to permanent VPS in the treatment of PHH. Retrospective studies, mostly with small patients' numbers, provide not only a considerable controversy regarding EVD, VSG, VADs and ETV usefulness in the management of PHH but also variable rates on their complications. None of these variables have, however, been tested using RCTs.
  
  
  CONCLUSIONS
  There is no level-one evidence to support the superiority of any of the currently available temporising measures in the initial treatment of PHH over others. The need for such rigorous studies remains largely unmet. We feel that a UK multi-centre-RCT is paramount to provide neurosurgeons with the evidence needed to choose the best initial approach for PPH treatment, yet with minimal complications' rate.
authors.affiliation: a Institute of Psychological Medicine and Clinical Neurosciences, National Neuroscience and Mental Health Research Institute, Cardiff University School of Medicine , Cardiff , UK.|b Department of Paediatric Neurosurgery , University Hospital of Wales , Cardiff , UK.
authors.forename: Malik
authors.initials: M
authors.lastname: Zaben
authors.affiliation: a Institute of Psychological Medicine and Clinical Neurosciences, National Neuroscience and Mental Health Research Institute, Cardiff University School of Medicine , Cardiff , UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Finnigan
authors.affiliation: b Department of Paediatric Neurosurgery , University Hospital of Wales , Cardiff , UK.
authors.forename: Muhammed I
authors.initials: MI
authors.lastname: Bhatti
authors.affiliation: b Department of Paediatric Neurosurgery , University Hospital of Wales , Cardiff , UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Leach
mesh_terms: D002543:Cerebral Hemorrhage / Q000601:surgery*; D002552:Cerebral Ventricles / Q000601:surgery*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects / Q000379:methods; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007234:Infant, Premature; D019635:Neurosurgical Procedures
keywords: cerebrospinal fluid drainage; hydrocephalus; intraventricular haemorrhage; ventriculoperitoneal shunt