title: Introduction of percutaneous-tunneled transfontanellar external ventricular drainage in the management of hydrocephalus in extremely low-birth-weight infants.
abstract: OBJECTIVE Hydrocephalus treatment in extremely low-birth-weight (ELBW) infants still represents a challenge for the pediatric neurosurgeon, particularly when the patient weighs far less than 1000 g. In such cases, the benefits in terms of neurological outcome following early treatment do not always outweigh the surgical risks, especially considering the great difference in the surgical risk before patient weight increases. To assess the efficacy and reliability of a percutaneous-tunneled, transfontanellar external ventricular drain (PTTEVD) in ELBW infants, the authors started a new protocol for the early surgical treatment of hydrocephalus. METHODS Ten cases of posthemorrhagic hydrocephalus (PHH) in ELBW infants (5 cases < 700 g, range for all cases 550-1000 g) were treated with a PTTEVD that was implanted at bedside as the first measure in a stepwise approach. RESULTS The average duration of the procedure was 7 minutes, and there was no blood loss. The drain remained in place for an average of 24 days (range 8-45 days). In all cases early control of the hydrocephalus was achieved. One patient had a single episode of CSF leakage (due to insufficient CSF removal). In another patient Enterococcus in the CSF sample was detected the day after abdominal surgery with ileostomy (infection resolved with intrathecal vancomycin). One patient died of Streptococcus sepsis, a systemic infection existing prior to drain placement that never resolved. One patient had Pseudomonas aeruginosa sepsis prior to drain insertion; a PTTEVD was implanted, the infection resolved, and the hydrocephalus was treated in the same way as with a traditional EVD, while the advantages of a quick, minimally invasive, bedside procedure were maintained. Once a patient reached 1 kg in weight, when necessary, a ventriculoperitoneal shunt was implanted and the PTTEVD was removed. CONCLUSIONS The introduction of PTTEVD placement in our standard protocol for the management of PHH has proved to be a wise option for small patients.
authors.affiliation: Pediatric Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital;
authors.forename: Mino
authors.initials: M
authors.lastname: Zucchelli
authors.affiliation: Pediatric Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital;
authors.forename: Mariella
authors.initials: M
authors.lastname: Lefosse
authors.affiliation: Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital;
authors.forename: Luigi
authors.initials: L
authors.lastname: Corvaglia
authors.affiliation: Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital;
authors.forename: Silvia
authors.initials: S
authors.lastname: Martini
authors.affiliation: Neonatal Intensive Care Unit, Maternal and Pediatrics Department, Maggiore Hospital, Bologna;
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Sandri
authors.affiliation: Neonatal Intensive Care Unit, Maternal and Pediatrics Department, Maggiore Hospital, Bologna;
authors.forename: Silvia
authors.initials: S
authors.lastname: Soffritti
authors.affiliation: Neonatal Intensive Care Unit, Infermi Hospital, Rimini;
authors.forename: Gina
authors.initials: G
authors.lastname: Ancora
authors.affiliation: Neonatal Intensive Care Unit, Infermi Hospital, Rimini;
authors.forename: Palma
authors.initials: P
authors.lastname: Mammoliti
authors.affiliation: Neonatal Intensive Care Unit, Obstetrics, Gynecology and Pediatrics Department, Arcispedale Santa Maria Nuova Hospital, IRCCS, Reggio Emilia, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Gargano
authors.affiliation: Pediatric Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital;
authors.forename: Ercole
authors.initials: E
authors.lastname: Galassi
mesh_terms: D002552:Cerebral Ventricles / Q000000981:diagnostic imaging / Q000601:surgery*; D055762:Cranial Fontanelles / Q000000981:diagnostic imaging / Q000601:surgery*; D019468:Disease Management; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000601:surgery*; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D019102:Infant, Very Low Birth Weight; D008297:Male; D017287:Ventriculoperitoneal Shunt / Q000379:methods
keywords: ELBW = extremely low birth weight; EVD = external ventricular drain; IVH = intraventricular hemorrhage; NICU = neonatal intensive care unit; PHH = posthemorrhagic hydrocephalus; PTTEVD = percutaneous-tunneled, transfontanellar EVD; PVD = posthemorrhagic ventricular dilation; extremely low-birth-weight infants; hydrocephalus