title: Surgical management of hydrocephalus secondary to intraventricular hemorrhage in the preterm infant.
abstract: OBJECT Posthemorrhagic hydrocephalus (PHH) in the preterm infant remains a major neurological complication of prematurity. The authors first described insertion of a specially designed low-profile subcutaneous ventricular catheter reservoir for temporary management of hydrocephalus in 1983. This report presents the follow-up experience with the surgical management of PHH in this population and describes outcomes both in infants who were stable for permanent shunt insertion and those initially temporized with a ventricular reservoir (VR) prior to permanent ventriculoperitoneal (VP)/ventriculoatrial (VA) shunt placement. METHODS A retrospective review was undertaken of the medical records of all premature infants surgically treated for posthemorrhagic hydrocephalus (PHH) between 1997 and 2012 at Children's Hospital Los Angeles. RESULTS Over 14 years, 91 preterm infants with PHH were identified. Fifty neonates received temporizing measures via a VR that was serially tapped for varying time periods. For the remaining 41 premature infants, VP/VA shunt placement was the first procedure. Patients with a temporizing measure as their initial procedure had undergone CSF diversion significantly earlier in life than those who had permanent shunting as the initial procedure (29 vs 56 days after birth, p < 0.01). Of the infants with a VR as their initial procedure, 5/50 (10%) did not undergo subsequent VP/VA shunt placement. The number of shunt revisions and the rates of loculated hydrocephalus and shunt infection did not statistically differ between the 2 groups. CONCLUSIONS Patients with initial VR insertion as a temporizing measure received a CSF diversion procedure significantly earlier than those who received a permanent shunt as their initial procedure. Otherwise, the outcomes with regard to shunt revisions, loculated hydrocephalus, and shunt infection were not different for the 2 groups.
authors.affiliation: Department of Neurosurgery, Keck School of Medicine, University of Southern California; and.
authors.forename: Eisha A
authors.initials: EA
authors.lastname: Christian
authors.affiliation: Division of Neurosurgery, Children's Hospital, Los Angeles, California.
authors.forename: Edward F
authors.initials: EF
authors.lastname: Melamed
authors.affiliation: Department of Neurosurgery, Keck School of Medicine, University of Southern California; and.
authors.forename: Edwin
authors.initials: E
authors.lastname: Peck
authors.affiliation: Department of Neurosurgery, Keck School of Medicine, University of Southern California; and.|Division of Neurosurgery, Children's Hospital, Los Angeles, California.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Krieger
authors.affiliation: Department of Neurosurgery, Keck School of Medicine, University of Southern California; and.|Division of Neurosurgery, Children's Hospital, Los Angeles, California.
authors.forename: J Gordon
authors.initials: JG
authors.lastname: McComb
mesh_terms: D001724:Birth Weight; D002543:Cerebral Hemorrhage / Q000150:complications; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000601:surgery*; D015141:Los Angeles; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects
keywords: IVH = intraventricular hemorrhage; LP = lumbar puncture; NEC = necrotizing enterocolitis; PHH = posthemorrhagic hydrocephalus; VA = ventriculoatrial; VP = ventriculoperitoneal; VR = ventricular reservoir; VSG = ventriculosubgaleal; intraventricular hemorrhage; posthemorrhagic hydrocephalus; preterm infant; ventricular reservoir; ventriculoperitoneal shunt