Anatomical configurations associated with posthemorrhagic hydrocephalus among premature infants with intraventricular hemorrhage

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Intraventricular hemorrhage (IVH) is a complication of prematurity often associated with ventricular dilation, which may resolve over time or progress to posthemorrhagic hydrocephalus (PHH). This study investigated anatomical factors that could predispose infants with IVH to PHH.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors analyzed a cohort of premature infants diagnosed with Grade III or IV IVH between 2004 and 2014. Using existing ultrasound and MR images, the CSF obstruction pattern, skull shape, and brain/skull ratios were determined, comparing children with PHH to those with resolved ventricular dilation (RVD), and comparing both groups to a set of healthy controls.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Among 110 premature infants with Grade III or IV IVH, 65 (59%) developed PHH. Infants with PHH had more severe ventricular dilation compared with those with RVD, although ranges overlapped. Intraventricular CSF obstruction was observed in 36 (86%) of 42 infants with PHH and 0 (0%) of 18 with RVD (p &lt; 0.001). The distribution of skull shapes in infants with PHH was similar to those with RVD, although markedly different from controls. No significant differences in supratentorial brain/skull ratio were observed; however, the mean infratentorial brain/skull ratio of infants with PHH was 5% greater (more crowded) than controls (p = 0.006), whereas the mean infratentorial brain/skull ratio of infants with RVD was 8% smaller (less crowded) than controls (p = 0.004).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Among premature infants with IVH, intraventricular obstruction and infratentorial crowding are strongly associated with PHH, further underscoring the need for brain MRI in surgical planning. Prospective studies are required to determine which factors are cause and which are consequence, and which can be used to predict the need for surgical intervention.</jats:p></jats:sec>

Preterm neuroimaging and neurodevelopmental outcome: a focus on intraventricular hemorrhage, post-hemorrhagic hydrocephalus, and associated brain injury

“…Qualitative MRI at term-corrected age for former preterm infants has good prognostic value for predicting CP as mentioned earlier [69, 70]. Moderate to severe white matter abnormalities including PVL are most indicative of later motor disability.…”

“…MRI is superior to HUS when assessing the total burden of ventriculomegaly as it can better visualize the 3rd and 4th ventricles, assessing posterior fossa crowding and 4th ventricle outlet obstruction and dilation, which can be seen in PHVD. Intraventricular obstruction may happen secondary to altered CSF flow dynamics after shunting or anatomical changes after IVH [70], unfortunately there is not sufficient literature on the neurodevelopmental importance of 3rd or 4th ventricle dilation. See Fig.…”

Intraventricular haemorrhage and posthaemorrhagic ventricular dilatation: moving beyond CSF diversion

“…3). In addition to the clinical utility, MRI at term-equivalent age, including assessment of the Kidokoro score and ventricular volumes, has been shown to be useful in predicting subsequent neurodevelopmental outcomes [29,30]. In large series, VP shunt conversion rates in the literature vary widely from 63 to 95% [31][32][33][34][35].…”

Bloody Ventriculography: Intracerebral Hemorrhage Artistically Casting the Ventricular System’s Anatomy Into a Bird’s Head

“…FIGURE 2: Crax rubra.A photograph by Zinn, N. (2020). Great Curassow (Crax rubra) 2048×1638[17] with permission.…”